The rate of fracture was 20% in the intervention group and 16% in the placebo group (no statistically significant difference). The study was not powered to examine facture reduction and larger trials are needed to determine whether the improvements in BMD translate into a benefit in terms of fracture reduction.
The author of a related commentary notes that there were a number of imbalances between the groups in terms of non-skeletal risk factors, despite randomisation, and that these suggest participants treated with zoledronic acid were at greater risk of fracture than those in the placebo group. They say that clinicians must address the non-skeletal components of risk that will not be modified by bone-acting drugs, to effectively reduce fractures in such a frail population.
Overall they say that it would be premature to modify the clinical use of bone-active agents in a nursing home population with osteoporosis based on the results of this study. Although likely to be difficult, studies of fall prevention strategies, including bone active drugs, are needed in this high risk population.