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Fracture prevention in patients with cognitive impairment presenting with a hip fracture: secondary analysis of data from the HORIZON Recurrent Fracture Trial


Prieto-Alhambra, D., Judge, A., Arden, N. K., Cooper, C., Lyles, K. W., Javaid, M. K.


Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, Volume: 25, No.: 1, Pages.: 77-83

Year of Publication



Unlabelled: Patients with cognitive impairment (CI) often do not receive secondary fracture prevention. Use of zoledronic acid led to a similar reduction in re-fracture risk but the survival benefit was limited to those without CI.; Introduction: We tested whether the effects of id (Zol) on re-frazoledronic accture and mortality differed in patients presenting with a hip fracture by cognitive status.; Methods: We used data from the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Recurrent Fracture Trial, of yearly intravenous 5 mg Zol vs. placebo in patients presenting with a hip fracture. Primary outcome was new fracture and secondary outcome mortality. Short Portable Mental Status Questionnaire (SPMSQ) with a cut-point of >2 was used to identify CI. Fine-Gray models for competing events were fitted to study the effect of Zol on re-fracture and Cox regression for death. A multiplicative term was introduced to study a potential interaction between treatment and cognitive status on outcomes.; Results: Baseline SPMSQ of 1,966/2,127 (92.4%) patients was measured. Three hundred fifty (17.8%) had CI, balanced between treatment arms. In the placebo arm, there was similar fracture incidence between those with and without CI (15.4 vs. 12.3%, p = 0.26). There was no significant interaction for the effect of CI on Zol and re-fracture (p = 0.66). CI was associated with higher 1-year mortality (12.6 vs. 4.3%, p < 0.001) and the interaction was bordering significance (interaction, p = 0.066). Zol prolonged survival only in patients with normal cognitive status [HR 0.56 (95% CI 0.40-0.80)] and not in those with CI [HR 0.90 (95% CI 0.59-1.38)].; Conclusions: While these results require confirmation, the findings support the use of bisphosphonates in patients with osteoporotic fracture and CI expected to live for more than 6 months.;

Bibtex Citation

@article{Prieto_Alhambra_2013, doi = {10.1007/s00198-013-2420-8}, url = {}, year = 2013, month = {jun}, publisher = {Springer Science $mathplus$ Business Media}, volume = {25}, number = {1}, pages = {77--83}, author = {D. Prieto-Alhambra and A. Judge and N. K. Arden and C. Cooper and K. W. Lyles and M. K. Javaid}, title = {Fracture prevention in patients with cognitive impairment presenting with a hip fracture: secondary analysis of data from the {HORIZON} Recurrent Fracture Trial}, journal = {Osteoporosis International} }


acid, aged, aged, 80 and over, bone density conservation agents, cognition disorders, complications, diphosphonates, double-blind method, drug therapy, epidemiology, etiology, female, hip, hip fractures, humans, imidazoles, incidence, male, middle aged, osteoporosis, osteoporotic fractures, prevention & control, psychiatric status rating scales, recurrence, refractures, therapeutic use, treatment outcome, zoledronic

Countries of Study

Spain, UK, USA

Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Carer Burden (instruments measuring burden), Prevention and/or management of co-morbidities

Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions