Bone is the part of body that most common for metastasis solid tumors. Bisphosphonates are an effective treatment for preventing bone damage events and improve quality of life patients. Zoledronic acid (ZOL) is the third generation of nitrogen-containing bisphosphonates (NBPs) that can inhibit osteoclasts in the process of bone resorption. Mechanism action of this drug related to affinity with hydroxyapatite crystals of bone, through a high bone turnover result in reducing speed of bone remodeling. This drug has higher affinity compared with other bisphosphonates for bonding hydroxyapatite . Zoledronic acid internalizes into osteoclasts, which disrupts the metabolic process and function of osteoclast cells and accelerates the occurrence of apoptosis. In the other hand it has adverse drug reactions mild to moderate which have reported but the mechanism still unclear such as hypocalcaemia and secondary hypophosphatemia, acute phase response (APR), renal toxicity, and osteonecrosis of the jaw (ONJ). Adverse drug reaction can cause harm to patient indeed arise death, highly recommended to offer monitoring for patients.
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