Cost-Effectiveness of One-Year Preoperative Bisphosphonate Therapy in Preventing Periprosthetic Fracture After Total Hip Arthroplasty: Break-Even Analysis

The cost-effectiveness of treating osteoporosis, a risk factor for periprosthetic fracture, in patients undergoing total hip arthroplasty (THA) remains unclear. Economic viability of one-year preoperative administration of U.S. Food and Drug Administration approved bisphosphonate medications for the prevention of periprosthetic fractures was assessed using price data from the National Average Drug Acquisition Cost database. With an incidence of periprosthetic hip fracture of 0.75% and the cost of treating periprosthetic hip fracture at $65,525, zoledronate, alendronate, ibandronate and risedronate are deemed cost-effective for a one-year treatment regimen if they prevented one event of periprosthetic hip fracture out of 6,270 (absolute risk reduction [ARR] = 0.016%), 4,345 (ARR = 0.023%), 1,270 (ARR = 0.079%) and 708 (ARR = 0.141%) cases of THA, respectively. If bisphosphonates are clinically efficacious in reducing periprosthetic hip fracture risk, preoperative therapy is an economically viable intervention across a range of medications and baseline fracture rates. (Journal of Surgical Orthopaedic Advances 35(3):145–148, 2026)

Key words: total hip arthroplasty, osteoporosis, periprosthetic fracture, bisphosphonate, economic cost