The administration of zoledronic acid (ZA) to patients who received cementless total hip arthroplasty (THA) has been reported to reduce bone turnover markers (BTMs) and increase bone mineral density (BMD). The effects of two-dose ZA versus placebo on cementless THA patients were analyzed in this five-year extension study. Alkaline phosphatase (ALP), osteocalcin (OC), procollagen 1 intact N-terminal propeptide (P1NP), serum calcium, renal function, radiological findings, and functional outcomes were compared in 49 patients, and the periprosthetic BMD of seven Gruen zones were compared in 19 patients. All the patients had normal renal function and calcium levels at their final follow-up. The mean ALP level in the ZA group was significantly lower at the fifth year, mean OC levels were significantly lower at the second and fifth year, and mean P1NP levels were significantly lower from 6 weeks to 5 years as compared with the control group. Fifth-year BMD levels were not found to be different between the ZA and control groups. The BMD Change Ratios in the ZA group were significantly increased in Gruen zone 6 at 1, 2, and 5 years. Our study results suggest that short-term ZA treatment with a subsequent 4-year drug holiday may inhibit serum BTMs and provide periprosthetic bone preservation at five years without adverse events.

Background: Anemia in intertrochanteric fractures (ITFs) is associated with higher morbidity and mortality and is an independent risk factor of functional mobility. Numerous studies have examined blood loss after different fixation systems. However, there is limited literature assessing the correlation of different variables that could influence blood loss in ITFs. The purpose of this study is to assess blood loss in ITFs stabilized using either dynamic hip screw (DHS) or cephalomedullary nail (CMN). Materials and methods: Perioperative blood loss was evaluated in 621 consecutive patients treated for ITFs with DHS and CMN between March 2011 and January 2021. Estimated blood loss (EBL) was calculated using the modified Lisander formula. Multivariable linear regression was performed to assess associations between implant type and EBL, adjusting for age, sex, BMI, ASA score, fracture pattern (AO/OTA type 31A1 and 31A2), anticoagulant use, and time to surgery (early: <48 h vs. late: ≥48 h). Results: DHS was associated with significantly lower EBL (613.7 mL vs. 728.7 mL; p < 0.001). In multivariable analysis, CMN was independently associated with higher blood loss (β = 119.4 mL; 95% CI 42.2–196.7; p = 0.003). Use of anticoagulants, male sex, and higher fracture severity (A2 vs. A1) were also associated with increased blood loss. DHS showed a trend toward lower transfusion volume (CMN vs. DHS, β = 65.3 mL; 95% CI -46.8–102.0; p = 0.138), though implant type was not a significant predictor of transfusion requirement (CMN vs. DHS, OR = 1.040; p = 0.212). Surprisingly, anticoagulant use was associated with slightly lower EBL (β= -109.5 mL; 95% CI -186.7– -32.3; p = 0.006). Conclusions: DHS was associated with lower perioperative blood loss and reduced transfused volume compared to CMN in AO/OTA type 31A1 and 31A2 ITFs. These findings support DHS as a potential option for patients at higher risk of anemia or transfusion-related complications.