ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2011) 25 P18

The long-term safety and efficacy of zoledronic acid in the treatment of osteoporosis: a 3-year, randomized extension to the HORIZON-pivotal fracture trial (PFT)

Richard Eastell1, Ian Reid2, Jane Cauley3, Steven Boonen4, Felicia Cosman5, Ping Chung Leung6, Péter Lakatos7, Zulema Man8, Steven Cummings9, Trisha Hue10, MaryEllen Ruzycky11, Ruvie Martinez11, Guoqin Su11, Christina Bucci-Rechtweg11 & Dennis Black10


1University of Sheffield, Sheffield, UK; 2University of Auckland, Auckland, New Zealand; 3University of Pittsburgh, Pittsburgh, Pennsylvania, USA; 4Katholieke Universiteit Leuven, Leuven, Belgium; 5Helen Hayes Hospital, West Haverstraw, New York, USA; 6Chinese University of Hong Kong, Hong Kong, China; 7Semmelweis University Medical School, Budapest, Hungary; 8Centro Tratamiento Integral Endocrinología, Buenos Aires, Argentina; 9San Francisco Coordinating Center, San Francisco, California, USA; 10University of California, San Francisco, California, USA; 11Novartis Pharmaceuticals, East Hanover, New Jersy, USA.


Treatment with a single annual infusion of zoledronic acid 5 mg (ZOL) for 3 years has been shown to be effective in increasing bone mineral density (BMD) and decreasing fractures. In order to investigate the long-term effects of ZOL, we performed a 3-year extension of the HORIZON-PFT to 6 years. A total of 1233 women who received ZOL for 3 years in the core study were randomly allocated to 3 additional years of ZOL (Z6, n=616) or blinded placebo (Z3P3, n=617). Primary endpoint was percentage change in femoral neck (FN) BMD at year 6 relative to year 3. Secondary endpoints included other BMD sites, bone turnover markers, fractures and safety. FN BMD results are shown in the figure below. In the Z6 group, FN BMD remained constant in years 3–6 while it decreased slightly in the Z3P3 group (between treatment difference at year 6=1.04%, 95% CI: 0.43–1.65%, P=0.0009), and similar results were seen for total hip, trochanter and lumbar spine BMD. New vertebral morphometric fractures were lower in the Z6 group compared with the Z3P3 group (relative risk reduction of 52%, 95% CI: 10–74%, P=0.03), while there were no differences between groups in clinical, non-vertebral, hip, and clinical vertebral fractures. Biochemical markers remained constant in the Z6 group but rose slightly in the Z3P3 group, remaining below pretreatment levels in both groups. The overall incidence of adverse events was similar in both groups. A numerical increase in atrial fibrillation SAEs (2.0% in Z6 vs 1.1% in Z3P3) was not statistically significant (P=0.26). No new safety concerns were identified. The BMD results, together with the fracture results, suggest that patients at high risk of fracture, particularly vertebral fracture, should continue on annual ZOL therapy.