E053 Persistence with zoledronate in people at increased risk of fracture: a single UK centre service evaluation

Royle, Jenny; Hawarden, Ashley; Bullock, Laurna; Paskins, Zoe

Abstract

Background/Aims Oral bisphosphonates are both cost and clinically effective in terms of fracture risk reduction. However, effective treatment with oral bisphosphonates is often compromised by suboptimal persistence. For instance, persistence with oral bisphosphonates is between 16-60% at one year. This is due to a range of factors thought to include side effects, complex administration instructions and uncertainty regarding benefit. Intravenous zoledronate has theoretical advantages in that it is given less often (typically annually for three years or more) and is more clinically effective in terms of fracture risk reduction. However, there is little data, particularly in a UK setting, on persistence. This retrospective service evaluation reports real-world long-term adherence to, and persistence with, zoledronate from a single centre, UK NHS hospital. Methods All patients treated with zoledronate at the Midlands Metabolic Bone Centre between January 2015 and January 2020 were retrospectively identified from service records. Exclusion criteria included people who had received zoledronate for an alternative reason other than increased fracture risk (e.g. Paget’s disease), died within 12 months of the first treatment and prevalent zoledronate users at the study entry date. Based on previous research the accepted treatment window was 12 months (or 18 months during COVID due to departmental policies) +/- 90 days. Data were extracted using a bespoke extraction form on Microsoft Excel. If the inclusion criteria were met, the date of the 1st, 2nd and 3rd zoledronate treatments were extracted. Early discontinuation was defined as people who had not received three or more treatments unless they had died, or treatment was ongoing. The reason for early discontinuation was recorded and later categorised into adverse events (e.g., typical side effects), rare adverse events (e.g., atypical femoral fracture), medical reasons (e.g., progression of chronic kidney disease), rationalisation of medication (e.g., terminal illness), informed patient choice and other reasons (e.g., failure of the unit to follow-up). The project was registered as a service evaluation with the Midlands Partnership University NHS Foundation Trust. Results A total of 575 people received at least one treatment with zoledronate. 547 (95.13%) received three or more treatments, 23 (4.00%) 2 treatments and 5 (0.87%) one treatment. Second treatment and third treatment persistence were 82.1% and 80.2% respectively. 19 people discontinued treatment early. Reasons for early discontinuation included informed patient choice (n = 6), other reasons (n = 5), medical reasons (n = 5), rationalisation of medication (n = 1), adverse event (n = 1) and rare adverse event (n = 1). Conclusion Real-world persistence with zoledronate in our single NHS centre is high. Therefore, more work is needed to determine if high persistence is replicated across other NHS sites and to determine the influence of persistence on estimates of cost-effectiveness of zoledronate, and consideration of cost effectiveness of first line zoledronate versus oral bisphosphonates. Disclosure J. Royle: None. A. Hawarden: None. L. Bullock: None. Z. Paskins: Other; Keele University has received sponsorship from UCB Pharma Limited.

Citation

Royle, J., Hawarden, A., Bullock, L., & Paskins, Z. (2025, April). E053 Persistence with zoledronate in people at increased risk of fracture: a single UK centre service evaluation. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 28, 2025
• Deposit Date: Jun 6, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.289
• Public URL: https://keele-repository.worktribe.com/output/1242699
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.289/8115251