Zoledronic acid for osteoporosis and associated low-energy fractures

Abstract

Zoledronic acid is a third-generation amino-containing BF that has been used to treat patients with osteoporosis for more than 15 years. Over the years, numerous experimental and clinical studies have proven the high efficacy of the drug in osteoporosis, both in women of various age groups, and in men, with primary and secondary osteoporosis, in patients with varying degrees of bone loss and risk of fractures. Intravenous infusions of zoledronic acid have been shown to result in a rapid gain of bone mass, a significant reduction in the risk of low-energy fractures of the vertebrae (spine), proximal femoral and nonvertebral fractures on the whole. However, in recent years, the use of the drug has significantly decreased, which is associated both with the lack of awareness of primary care physicians about the possibilities of this drug, and the fear of such complications of its use as atypical fractures and osteonecrosis of the jaw bones. The presented review aims to increase the knowledge of physicians regarding the mechanism of action of zoledronic acid, the regimens for prescribing the drug in various forms of osteoporosis and fractures against its background. The given clinical example shows the ability of zoledronic acid (osteostatics) to increase the mass of not only cancellous, but also the cortical bone of the proximal femur, which increases the role of zoledronic acid in the prevention of recurrent fractures. On top of that, the prolonged effect of the drug allows, when the desired therapeutic effect is achieved, to reduce the frequency of prescribing according to the ‘drug holiday’ principal, decreasing economic expenditures and medical and social burden.

Diagnostic analysis of toxic damage due to a dose of zoledronic acid

“…Bisphosphonate preparations have been widely used by various clinicists for more than 15 years, particularly aminobisphosphonates such as zoledronic acid (Rodionova et al 2022). Most of the current safety studies for zoledronic acid use included patients with osteoporosis of various etiologies, in which osteonecrosis of jawbone was detected in only 4.5 percent of patients per 10,000 (Kim 2021;Everts-Graber et al 2022).…”

“…It is known that the introduction of zoledronic acid in a number of patients is accompanied by side reactions, both early and late, the most common being influenzalike syndrome, which includes hyperthermia, weakness, nausea, and other symptoms. Mechanism is due to the inhibition of farnesylpyrophosphosphate synthase, which stimulates the production of monocytes of isopentenel pyrophosphate, resulting in the activation of gamma-delta CD14+ lymphocytes, which in the long term requires correction of treatment with bisphosphonic series drugs by the introduction of vitamin D3, to correct its insufficiency and drugs that eliminate hypocalcium, arising in the same conditions (Dhillon 2016;Rodionova et al 2022).…”