Abstract (Summary)
The manufacturer and the American Dental Association recommend that major dental work be completed before treatment is started and that invasive dental procedures be avoided during treatment1,2; however, one study with more than 3,000 patients receiving zoledronic acid did not demonstrate any instance of osteonecrosis following a dental procedure.3 An acute phase reaction characterized by fever, bone pain, myalgias, and arthralgias may occur shortly after the drug is administered. In combination with calcium and vitamin D, yearly treatment with zoledronic acid decreases the risk of hip fracture, with one fracture prevented for every 107 patients treated for three years (number needed to treat [NNT] = 107; 95% confidence interval [CI], 64.7 to 290.7).
PRICE Zoledronic acid costs approximately $1,250 per dose, given once a year. This course of treatment costs less than one year of intravenous ibandronate (Boniva) given every three months ($1,940), but costs more than one year of any of the oral bisphosphonates given monthly. SIMPLICITY Zoledronic acid is administered as a 5-mg, 15-minute infusion once a year. It should not be used in women with a creatinine clearance of less than 35 mL per minute (0.58 mL per second), and patients should be well hydrated before the infusion is given, especially if receiving diuretic treatment. Patients need to take usual daily dosages of calcium (1,000 to 1,500 mg) and vitamin D (800 to 1,000 IU).1 Bottom Line Zoledronic acid, in combination with calcium and vitamin D, will reduce the risk of vertebral fractures, and to a lesser extent, hip fractures in women with osteoporosis. It decreases subsequent fractures and mortality in high-risk patients who have had a hip fracture. Zoledronic acid may be most useful for women who are unable to tolerate, or have difficulty remembering to take, oral bisphosphonates. |
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