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. 2023 Sep;34(9):1613-1623.
doi: 10.1007/s00198-023-06803-w. Epub 2023 May 29.

The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients

K Lu  1 , Y-M Wu  1 , Q Shi  2 , Y-Q Gong  3 , T Zhang  4 , C Li  5
Affiliations

The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients

K Lu et al. Osteoporos Int. 2023 Sep.

Abstract

This study involving 674 elderly osteoporotic fracture (OPF) patients undergoing orthopedic surgery investigated the long-term outcomes of acute phase reaction (APR) after initial zoledronic acid (ZOL). Those who had an APR had a 97% higher risk of mortality and a 73% lower rate of re-fracture than patients who did not.

Introduction: Annual infusion of ZOL efficiently decreases the risk of fracture. A temporary APR, consisting of flu-like symptoms, myalgia, and fever, is frequently observed within 3 days after the first dose. This work aimed to identify whether the occurrence of APR after initial ZOL infusion is a reliable indicator of drug efficacy for mortality and re-fracture in elderly OPF patients undergoing orthopedic surgery.

Methods: This retrospectively observed work was constructed on a database prospectively collected from the Osteoporotic Fracture Registry System of a tertiary level A hospital in China. Six hundred seventy-four patients 50 years old or older with newly identified hip/morphological vertebral OPF who received ZOL for the first time after orthopedic surgery were included in the final analysis. APR was identified as a maximum axillary body temperature greater than 37.3 °C for the first 3 days after ZOL infusion. We utilized models of multivariate Cox proportional hazards to compare the risk of all-cause mortality in OPF patients with APR (APR+) and without APR (APR-). Competing risks regression analysis was used to examine the association between the occurrence of APR and re-fracture when mortality was taken into account.

Results: In a fully adjusted Cox proportional hazards model, APR+ patients had a significantly higher risk of death than APR- patients with a hazard ratio [HR] 1.97 (95% CI, 1.09-3.56; P-value = 0.02). Furthermore, in an adjusted competing risk regression analysis, APR+ patients had a significantly reduced risk of re-fracture compared with APR- patients with a sub-distribution HR, 0.27 (95% CI, 0.11-0.70; P-value = 0.007).

Conclusions: Our findings suggested a potential association between the occurrence of APR and increased mortality risk. An initial dose of ZOL following orthopedic surgery was found to be protective against re-fracture in older patients with OPFs.

Keywords: Acute-phase reaction; Elderly people; Mortality; Osteoporosis; Osteoporotic fracture; Re-fracture.

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References

    1. Bachour F, Rizkallah M, Sebaaly A, Barakat A, Razzouk H, El Hage R et al (2017) Fracture liaison service: report on the first successful experience from the Middle East. Arch Osteoporos 12(1):79 - PubMed - DOI
    1. van Geel TA, Huntjens KM, van den Bergh JP, Dinant GJ, Geusens PP (2010) Timing of subsequent fractures after an initial fracture. Curr Osteoporos Rep 8(3):118–122 - PubMed - PMC - DOI
    1. van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68(1):99–102 - PubMed - DOI
    1. Tran T, Bliuc D, Hansen L, Abrahamsen B, van den Bergh J, Eisman JA et al (2018) Persistence of Excess Mortality Following Individual Nonhip Fractures: A Relative Survival Analysis. J Clin Endocrinol Metab 103(9):3205–3214 - PubMed - DOI
    1. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882 - PubMed - DOI

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