When older adults break their hip, they’re at high risk for breaking bones again in the future. Doctors know a medicine called zoledronic acid can help prevent these repeat fractures, but most patients don’t get it. Researchers at a major hospital created a new program where a bone specialist (geriatrician) works with the orthopedic surgery team to offer this treatment to hip fracture patients while they’re still in the hospital. In their first 20 months, they successfully treated about 4 out of 10 eligible patients before they went home. The program was safe, didn’t delay anyone’s discharge, and only took about 30 minutes per patient to complete.

The Quick Take

  • What they studied: Can a hospital program successfully give bone-strengthening medicine to older adults with hip fractures while they’re still admitted for surgery?
  • Who participated: 232 patients age 65 and older who had hip fracture surgery at one academic hospital between September 2022 and May 2024. About three-quarters were women, with an average age of 84 years.
  • Key finding: Of 148 patients screened, 67 were eligible for the treatment, and 58 (39%) actually received the bone-strengthening medicine before leaving the hospital. The program was safe with no serious side effects or delays in discharge.
  • What it means for you: If you’re an older adult with a hip fracture, this program suggests your hospital might be able to start bone-strengthening treatment before you go home, which could help prevent future fractures. However, you’ll need adequate kidney function and vitamin D levels to qualify.

The Research Details

Researchers followed a group of older adults (age 65+) who had hip fracture surgery at one large academic hospital over a 20-month period. They created a new program where a geriatrician (a doctor who specializes in older adults) worked alongside the orthopedic surgeons to identify patients who could benefit from zoledronic acid, a medicine that strengthens bones. The program screened patients for eligibility based on kidney function and vitamin D levels, then offered the treatment to those who qualified before they left the hospital.

The researchers tracked how many patients were admitted, how many were screened, how many were eligible, and how many actually received the treatment. They also noted why some patients couldn’t receive it and whether the program caused any problems like delays in discharge or side effects.

This approach is practical because it catches patients at a critical moment—right after hip fracture surgery—when they’re already in the hospital and most likely to receive preventive treatment.

Most older adults who break their hip never receive bone-strengthening treatment, even though guidelines recommend it. This happens because patients are discharged quickly and may not follow up with their regular doctor. By offering treatment while patients are still hospitalized, this program removes barriers and makes it more likely people will actually get the medicine they need to prevent future fractures.

This is preliminary data from a single hospital, so results may not apply everywhere. The study carefully tracked all patients and documented reasons for ineligibility, which is good. However, the researchers didn’t compare this program to usual care, so we can’t say for certain it’s better than other approaches. The short follow-up period means we don’t yet know if the treatment actually prevented future fractures in these patients.

What the Results Show

During the 20-month study period, 232 older adults with hip fractures were admitted to the co-managed care program. Of these, 148 patients were screened for eligibility to receive zoledronic acid. The screening process identified 67 patients (45%) who met the basic requirements (adequate kidney function and vitamin D levels). Of those eligible patients, 58 (39% of all screened patients) actually received the bone-strengthening injection before leaving the hospital.

The program ran smoothly without any serious problems. No patients experienced adverse reactions to the medicine, and importantly, the treatment didn’t delay anyone’s hospital discharge. On average, the screening and treatment process took about 30 minutes per patient, making it a practical addition to the hospital stay.

The most common reasons patients couldn’t receive the treatment were: low vitamin D levels (32% of ineligible patients), inadequate kidney function (21%), and the fact that they were already receiving osteoporosis treatment at home (30%). This information is valuable because it shows doctors where to focus—ensuring patients have adequate vitamin D and kidney function before hip fracture surgery.

The program successfully integrated geriatric care into the orthopedic trauma service, demonstrating that specialists from different fields can work together effectively. The fact that no adverse events occurred suggests the medicine is safe for this population when properly screened. The relatively short time investment (30 minutes) indicates the program is efficient and doesn’t burden hospital staff significantly.

Previous research has shown that most hip fracture patients don’t receive bone-strengthening treatment after their injury, despite clear guidelines recommending it. This new program appears to address that gap by treating patients while they’re hospitalized. The 39% treatment rate is higher than typical outpatient treatment rates, suggesting the inpatient approach works better. However, the researchers didn’t compare their program directly to other hospitals’ approaches, so we can’t say definitively that this method is superior.

This study has several important limitations. It only includes data from one hospital, so results may not apply to other medical centers with different resources or patient populations. The study is preliminary with only 20 months of data, so we don’t yet know if the treatment actually prevented future fractures or improved long-term outcomes. The researchers didn’t follow patients after discharge to see if they continued bone-strengthening treatment at home. Additionally, about 61% of screened patients didn’t receive the treatment, so the program still misses many patients who might benefit.

The Bottom Line

If you’re an older adult hospitalized with a hip fracture, ask your doctors about bone-strengthening treatment before you’re discharged. This research suggests it’s safe and practical to start during your hospital stay. Make sure your vitamin D levels are adequate and your kidney function is checked—these are the main factors determining eligibility. (Confidence level: Moderate—this is promising preliminary data, but more research is needed.)

This program is most relevant for older adults (65+) with hip fractures, their families, and healthcare providers at hospitals. It’s particularly important for people at high risk of future fractures. However, if you have severe kidney disease or very low vitamin D, you may not be eligible and should discuss alternatives with your doctor.

The medicine (zoledronic acid) works over months and years to strengthen bones. You won’t feel immediate effects, but the goal is to prevent fractures over the next several years. Most benefits appear after 6-12 months of treatment, though the full protective effect takes longer to develop.

Want to Apply This Research?

  • Track your vitamin D levels and kidney function test results every 3-6 months. Log these values in your health app along with any bone-related symptoms (pain, falls, or concerns about bone health) to share with your doctor.
  • If you receive zoledronic acid treatment, set a reminder to follow up with your doctor 4-6 weeks after discharge to confirm you received the injection and discuss any side effects. Also track your vitamin D intake through diet or supplements to maintain adequate levels.
  • Create a long-term tracking system that includes: (1) annual bone health check-ins with your doctor, (2) vitamin D level checks twice yearly, (3) kidney function tests annually, and (4) a fall prevention log to monitor any incidents that might indicate bone weakness.

This research describes a preliminary hospital program and should not be considered medical advice. The findings are from a single hospital and may not apply to all settings. If you have a hip fracture or osteoporosis, consult with your orthopedic surgeon and primary care doctor about whether zoledronic acid or other bone-strengthening treatments are appropriate for you. This is especially important if you have kidney disease, low vitamin D, or are already taking osteoporosis medications. Individual eligibility and safety depend on your specific health situation.