Zoledronic acid: clinical utility and patient considerations in osteoporosis and low bone mass

Hamdy, Ronald C.

doi:10.2147/dddt.s6287

Cited by 26 publications

(31 citation statements)

References 94 publications

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“…Zoledronic acid has been commonly used because of its high potency and ease of administration [7]. In the osteoporosis setting, its administration by IV infusion once a year virtually eliminates compliance issues and gastrointestinal side effects, thus leading to improved fracture protection and cost effectiveness [4]. Although zoledronic acid is generally well-tolerated, the most common side effects in- clude an acute-phase reaction, hypocalcemia, and renal toxicity [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…In the osteoporosis setting, its administration by IV infusion once a year virtually eliminates compliance issues and gastrointestinal side effects, thus leading to improved fracture protection and cost effectiveness [4]. Although zoledronic acid is generally well-tolerated, the most common side effects in- clude an acute-phase reaction, hypocalcemia, and renal toxicity [3,4]. Some of these side effects can be minimized by adequate calcium and vitamin D supplementation, generous rehydration, and discontinuation of drugs that potentiate renal toxicity, such as diuretics or non-steroidal anti-inflammatory compounds [3,4,6].…”

Section: Discussionmentioning

confidence: 99%

“…Although zoledronic acid is generally well-tolerated, the most common side effects in- clude an acute-phase reaction, hypocalcemia, and renal toxicity [3,4]. Some of these side effects can be minimized by adequate calcium and vitamin D supplementation, generous rehydration, and discontinuation of drugs that potentiate renal toxicity, such as diuretics or non-steroidal anti-inflammatory compounds [3,4,6]. The plasma concentrations of zoledronic acid are maximal at the end of the IV infusion, then rapidly decline to less than 10% in 4 h and to less than 1% 24 h after the infusion [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…The parenteral route of administration circumvents the poor adherence associated with oral bisphosphonates and the potential gastrointestinal side effects. Combined with its high efficacy in reducing the risk of vertebral and non-vertebral fractures, zoledronic acid is a reasonable option for elderly patients with comorbidities and those who do not tolerate or absorb oral bisphosphonates [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Side effects associated with the use of zoledronic acid include a transient and self-limiting acute-phase reaction, in particular during the first administration, mild to moderate hypocalcemia, mild and transient renal impairment, and rare osteonecrosis of the jaw or atypical femur fractures [3,4]. The majority of cases of hypocalcemia with zoledronic acid have been seen in cancer patients with bone metastases receiving a higher dosage and were mild or asymptomatic [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Severe Hypocalcemia After the Administration of Zoledronic Acid for Osteoporotic Fracture

Kim

2016

J Med Cases

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Zoledronic acid is a potent intravenous bisphosphonate used in the treatment of osteoporosis and malignancy-induced hypercalcemia or bone metastasis. Although zoledronic acid generally seems to be safe and well-tolerated, rare but life-threatening nephrotoxicity or hypocalcemia may occur. The majority of cases of hypocalcemia with zoledronic acid have been seen in patients with underlying malignancy and are asymptomatic or mild. Vitamin D deficiency, renal failure, hypoparathyroidism, and hypomagnesemia have been reported as risk factors for hypocalcemia. Here, the author reports a case of severe symptomatic hypocalcemia following the administration of zoledronic acid for the treatment of osteoporotic fracture. This patient also had underlying but unrecognized vitamin D deficiency and chronic kidney disease. Following the administration of calcium and vitamin D, her symptoms improved and calcium levels returned to normal within several days. To avoid serious hypocalcemia with zoledronic acid, calcium and vitamin D status and renal function should be assessed and corrected if appropriate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Severe Hypocalcemia After the Administration of Zoledronic Acid for Osteoporotic Fracture

Kim

2016

J Med Cases

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Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Bisphosphonates: Prevention of Bone Metastases in Breast Cancer

Gnant

Dubsky

Hadji

2012

Prevention of Bone Metastases

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Disease recurrence and distant metastases remain challenging for patients with breast cancer despite advances in early diagnosis, surgical expertise, and adjuvant therapy. Bone is the most common site for breast cancer metastasis, and the bone microenvironment plays a crucial role in harboring disseminated tumor cells (DTCs), a putative source of late relapse in and outside bone. Therefore, agents that affect bone metabolism might not only prevent the development of bone lesions but also provide meaningful reductions in the risk of relapse both in bone and beyond. Bisphosphonates bind to mineralized bone surfaces and are ingested by osteoclasts, wherein they inhibit osteolysis, thereby preventing the release of growth factors from the bone matrix. Therefore, the bone microenvironment becomes less conducive to survival and growth of DTCs and bone lesion formation. Recent trials of zoledronic acid in the adjuvant setting in breast cancer have demonstrated reduced disease recurrence in bone and other sites in premenopausal and postmenopausal women with early breast cancer. Based on the proven effect of bone protection during adjuvant endocrine therapy, new treatment guidelines recommend the routine use of bisphosphonates to prevent bone loss during adjuvant therapy, which may likely become the standard practice.

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Zoledronic acid: clinical utility and patient considerations in osteoporosis and low bone mass

Cited by 26 publications

References 94 publications

Severe Hypocalcemia After the Administration of Zoledronic Acid for Osteoporotic Fracture

Severe Hypocalcemia After the Administration of Zoledronic Acid for Osteoporotic Fracture

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Bisphosphonates: Prevention of Bone Metastases in Breast Cancer

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