Background: Zolendronic acid (ZA), a parenteral bisphosphonate, has proven fracture reduction efficacy. Strict criteria exist regarding eligibility for Pharmaceutical Benefits Scheme (PBS) subsidised ZA (1). International guidelines indicate that individuals not fulfilling PBS criteria may also benefit from ZA (2). Hospital patients not fulfilling PBS criteria may be prescribed ZA with costs borne by the health service. However, no assessment of patient numbers, clinical characteristics or outcomes to guide practice has been conducted. Objective: To evaluate the prevalence, clinical characteristics and treatment outcome of hospital patients prescribed ZA, but who did not fulfil PBS eligibility criteria (“non-PBS ZA”). Method: Retrospective audit of individuals >18 years, identified in hospital pharmacy records as receiving non-PBS ZA from January 2011-2015. Data collected: patient demographics, prescribing unit, osteoporosis risk factors/secondary screen and bone densitometry. The total number of patients prescribed ZA was recorded. Oncology patients were excluded. Data analysis included frequency statistics with median/(range) calculated. Results: From 2011-2015, 34/464 ZA prescriptions were designated non-PBS ZA. However, 17/34 had minimal trauma fractures (MTFs). Clinical Nutrition unit prescribed 55.6% of prescriptions with median cost of $535.5 ($446.4-$543.8)/prescription. Median age for non-PBS ZA individuals was 61 years (26-69) with 52.9% female. All individuals had ≥1 osteoporosis risk factor, with liver disease (41.2%) the commonest. Median T-scores at the lumbar spine (LS) and femoral neck (FN) were -2.6 (-4.4 to -0.9) and -2.3 (-5.3 to -1.5) respectively. T-scores ≤2.5 was observed in 53% LS and 41.2% FN of patients. Median change in LS and FN bone mineral density (BMD) post-ZA (n=3 infusions) was +6.8% (+6.3 to +6.9) and +1.2% (-5.5 to +10.7). Conclusion: Non-PBS ZA prescription is uncommon, however 50% of individuals were misclassified due to under-recognition of MTF. Individuals receiving non-PBS ZA were aged<70, had multiple risk factors with low LS/FN T-scores. ZA treatment increased BMD.