Inpatient Zoledronic Acid and Integrated Orthopedic and Fracture Liaison Services Improve Osteoporosis Treatment Rates

J Clin Endocrinol Metab. 2022 Dec 17;108(1):191-197. doi: 10.1210/clinem/dgac508.


Context: Fragility fractures increase risks for future fractures, morbidity, and mortality. Available pharmacotherapy for underlying osteoporosis is safe and effective but underused.

Objective: To improve pharmacotherapy rate representing secondary prevention of osteoporotic fractures.

Methods: This single-center, observational, follow-up study included patients with fragility fractures admitted to the Massachusetts General Hospital between February 2016 and December 2019. For patients admitted to the orthopedics service with fragility fracture, the Massachusetts General Hospital Fracture Liaison Service (FLS) was systematically consulted. Initial outpatient follow-up with FLS was established in conjunction with the orthopedic postoperative follow-up visit. Patients at risk for failing timely outpatient follow-up were administered zoledronic acid (ZA) during the index fracture hospitalization. The main outcome measures were percentage of patients with fragility fracture(s) started on pharmacotherapy for osteoporosis and average length of stay and 30-day readmission rate of patients treated with ZA.

Results: Compared with baseline (8-11%) and reference (5-20%) rates, integration of FLS to the orthopedics service, along with appropriate inpatient administration of ZA, increased the pharmacotherapy rate to 70% (412/589) among eligible patients with verified treatment status. Inpatient ZA administration neither affected the average length of stay nor 30-day readmission rate. Treatment status of 37.9% (471/1240) of the study patients remained unknown due to lack of or unknown follow-up.

Conclusion: Integration of a FLS and orthopedics services along with inpatient ZA administration improved the osteoporosis pharmacotherapy rate among patients with fragility fracture(s) who often had obstacles for outpatient follow-up.

Keywords: fracture liaison service; inpatient; osteoporotic fractures; pharmacotherapy; zoledronic acid.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Density Conservation Agents* / therapeutic use
  • Follow-Up Studies
  • Humans
  • Inpatients
  • Orthopedics*
  • Osteoporosis* / complications
  • Osteoporosis* / drug therapy
  • Osteoporotic Fractures* / drug therapy
  • Osteoporotic Fractures* / prevention & control
  • Secondary Prevention
  • Zoledronic Acid / therapeutic use


  • Zoledronic Acid
  • Bone Density Conservation Agents