Aims: To reduce costs associated with zoledronic acid (ZA) treatment in hospital, a metropolitan hospital introduced a policy mandating ZA administration on the day of discharge. This study aims to explore the impact of this policy on osteoporosis treatment in patients presenting with fragility fractures.
Methods: A retrospective pre-post study comparing osteoporosis treatment following minimal trauma fractures in adults >50 years discharged from subacute wards at a tertiary hospital during a 5-month period, before and after the policy change (24th September 2025).
Results: Out of 72 patients (mean age 83 ± 8.3 SD, female 61%, median Clinical Frailty Scale score =5) hip/femur fractures presentations were most common (n=39, 54%). 49 (68%) patients received osteoporosis treatment during admission, with poor renal function and dentition being the main barriers preventing treatment in the remaining 23 (32%). There was no difference in the proportion of patients receiving ZA pre policy (n=17, 65%) and post policy (n=18, 78%) (p=0.32). Hypocalcaemia (corrected calcium <2.10mmol/L) occurred in 8 (47%) patients in the pre policy group despite being vitamin D replete and without renal impairment (creatinine clearance >30ml/min). In the post policy group, there were 3 (9%) patients who missed osteoporosis treatment administration despite documented plans to treat on discharge (compared with 0 (0%) in the pre-policy group) (p=0.23).
Conclusions: Planned administration of ZA on day of discharge increases the risk of missed osteoporosis treatment and missed identification of adverse effects. Further research is required to determine how to balance cost reduction with optimal post-fracture care.