Efficacy of intravenous zoledronic acid in the prevention and treatment of osteoporosis:A meta-analysis

Objective:To compare the eflect of zoledronic acid in treatment and prevention of osteoporosis with placebo.Methods:Random control trials regarding zoleilroiiic acid in treatment of osteoporosis were retrieved by selecting Medline.EMbase and Pubmed databases till April 2012. The RevMan software was used for all of the statistical analysis.Results:A total of 9 trials were included in this meta-analysis.The pooled effect shewed that zoledronic acid could increase the bone mineral density by 2.98 times compared with placebo,and reduce the rate of fracture in patients by 32%.The results should the zoledronic acid intervention had significantly less serious adverse events than controls,and the odds ratio was 0.81(0.76-0.87).The longer term intervention, more than 12 months intervention,could gain a better prevention effect for osteoporosis(OR,95% CI for RMD was 3.35.2.77-3.92:for fracture was 0.67.0.54-0.82).Conclusions:This present study shows that zoledronic acid could be effective approach in the prevention of osteoporosis,and could increase the bone mineral density and reduce the risk ol facture.

Sandwich Structure-like Meshes Fabricated via Electrospinning for Controllable Release of Zoledronic Acid

Novel sandwich structure-like nanofiber multilayered meshes were fabricated via electrospinning. The purpose of the present work was to control zoledronic acid release via the novel structure of sandwich structure-like meshes. The in vitro release experiments reveal that the drug release speed and initial burst release were controllable by adjusting the thicknesses of electrospun barrier mesh and drug-loaded mesh. Compared with those of other drug delivery systems, the main advantages of the sandwich structure-like fiber meshes are facile preparation conditions and the generality for hydrophobic and hydrophilic pharmaceuticals.

The curative effect of zoledronic acid and pamidronic acid on treating ostealgia in malignant tumor with bone metastases and its side effects on serum calcium and phosphorus

Objective： Bisphosphonates were widely used with the rate of malignant tumor with bone metastases increasing rapidly. The aim of this study was to evaluate zoledronic acid and pamidronic acid on treating ostealgia of malignant tumor with bone metastases and serum calcium, phosphorus and alkaline phosphorus movement. Methods： One Hundred cancer patients with bone metastases were diagnosed according to pathological and imaging methods. After zoledronic acid or pamidronic acid intravenous infusion one and two months, ostealgia degree, serum calcium, serum phosphorus and alkaline phosphorus were observed before bisphosphonates treatment, one and two months after treatment, respectively. Results： Ostealgia degree did not change significantly after diphosphonates treatment from one to two months （P 〉 0.05）. The linear correlation between serum calcium and serum phosphorus on bone metastases cancer patients before therapy was dismissed after bisphosphonates treatment one month and did not recover in two months. The incidence of hypo-calcium after diphosphonate treatment one month （54%） and two months （56%） were significantly increased than that before treatment （36%） （X2 = 6.55, P = 0.011; X2 = 8.05, P = 0.005）. Serum calcium and serum phosphorus were both decreased after treatment one month （t = 4.39, P = 0.000; t = 2.50, P = 0.014） and two months （t = 4.32, P = 0.000; t = 2.49, P = 0.010）. There had no difference between zoledronic acid and pamidronic acid on treating of ostealgia and serum calcium and phosphorus changing. Conclusion： Zoledronic acid and pamidronic acid can relief ostealgia of cancer patients with bone metastases and induce hypo-calcium, break the linear relationship between calcium and phosphorus. There have no difference between zoledronic acid and pamidronic acid on treating ostealgia and inducing hypo-calcium and hypo-phosphorus.

A Study of Zoledronic Acid as Neo-Adjuvant, Perioperative Therapy in Patients with Resectable Pancreatic Ductal Adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy characterized by abundant granulocytic myeloid-derived suppressor cells (G-MDSC = CD45+/Lin﹣/CD33+/CD11b+/CD15+), which infiltrate tumors and suppress anti-tumor immunity. We have previously demonstrated in a murine model of PDAC that zoledronic acid (ZA) depletes G-MDSC resulting in decreased tumor growth and improved survival. We report here the results of a phase 1 clinical trial (NCT00892242) using ZA as neo-adjuvant, perioperative therapy in patients with non-metastatic, resectable pancreatic adenocarcinoma. Methods: Eligible PDAC patients received ZA (4 mg) IV 2 weeks prior to surgery. Patients then received 2 additional doses of ZA 4 weeks apart. Blood and bone marrow were obtained from patients prior to treatment with ZA and 3 months after surgery for analysis of G-MDSC by flow cytometry. Results: Twenty-three patients received pre-operative ZA with at least 6 months of follow-up. Only 15 PDAC patients had nonmetastatic PDAC, which was amenable to resection. ZA was well tolerated, and all adverse events were grade 1 or 2. The most common adverse events were fatigue, abdominal pain/discomfort, anorexia, and arthralgia. Of resected PDAC patients treated with ZA, 1- and 2-year overall survival (OS) was 85.7% and 33.3%, respectively, with a median OS of 18 months. This group had a 1- and 2-year progression-free survival (PFS) of 26.9% and 8.9%, respectively, with a median PFS of 12 months. The prevalence of G-MDSC was unchanged in the blood and bone marrow of PDAC patients pre- and post-treatment with ZA. Conclusion: ZA is safe and well tolerated as neo-adjuvant, peri-operative therapy in PDAC patients. In this small study, we did not observe a difference in OS or PFS compared to historical controls. Also, there was no difference in the prevalence of G-MDSC in the blood and bone marrow of PDAC patients pre- and post-treatment with ZA.

Curative Effect Analysis of Zoledronic Acid in the Treatment of Postmenopausal Osteoporosis with Different Bone Turnover Rates

Objective: To explore the clinical efficacy of Zoledronic Acid Injection in the treatment of postmenopausal osteoporosis with different bone turnover rates. Methods: A total of 63 patients diagnosed with postmenopausal osteoporosis were included in this study. Each patient was administrated 5 mg/100mL Zoledronic Acid (Aclasta) intravenously once and then given a one-year prescription of 600 mg/d oral Caltrate. The bone turnover parameters (PINP, β-cross, N-MID) were measured prior to the injection of Zoledronic Acid while the bone mineral density (BMD) and the pain scores of each patient were tested before treatment and after the one-year medication. On this basis, the patients were divided into several groups according to their bone turnover rates for intergroup comparison of treatment outcomes. Results: BMD results and pain scores of all participants were significantly improved at different levels after treatment. However, these improvements had no significant differences between the patients with high and low bone turnover rates. Conclusion: Zoledronic Acid Injection can relieve bone pain, enhance the quality of life and increase the BMD in patients with postmenopausal osteoporosis, regardless of the bone turnover status.

Zoledronic acid combined with androgendeprivation therapy may prolong time to castration-resistant prostate cancer in hormone-naı¨ve metastatic prostate cancer patients e A propensity scoring approach

Objective:To clarify the oncological benefit of zoledronic acid for hormone-naive metastatic prostate cancer,patient outcome of androgen deprivation therapy with zoledronic acid(ADT+Z)and androgen deprivation therapy alone(ADT)was compared.Methods:Fifty-two patients with pathologically confirmed metastatic prostate cancer were prospectively enrolled and treated with combined androgen blockade(goserelin and bicalutamide)with zoledronic acid(4 mg every 4 weeks for 24 months).A propensity score-match with logistic regression analysis was applied to select 50 pair-matched cohorts(both from ADT+Z and from historical control cohorts who had undergone ADT alone),and patient outcomes were compared.Results:Patients with ADT+Z had significantly longer time to progression(TTP)than those with ADT(median TTP;24.2 vs.14.0 months,p=0.0092),while no significant difference of overall survival between two groups(p=0.1502).Multivariate analysis for biochemical recurrence revealed treatment with ADT was the sole independent prognostic factor(HR:1.724,95%CI:1.06-2.86,p=0.0297).Conclusion:Combination of zoledronic acid with ADT may prolong time to castration resistant prostate cancer.

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

Background: Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. Purpose: To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). Method: A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (β-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. Results: After normalized treatment, the bone metabolism indexes of PINP and β-CTX were improved and BMD was increased in three groups. Adverse Reactions: There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). Conclusion: Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.

Efficacy and safety of radiotherapy combined with zoledronic acid in the treatment of lung cancer with bone metastasis: a meta-analysis

Objective: To evaluate the efficacy and safety of radiotherapy combined with zoledronic acid fOr the treatment of bone metastases. Methods: Use Pubmed, Cochrane Library, Embase, CBM, CNKI, Wanfang, Weipu tools to search-related databases at home and abroad. From 2013.1 to March 2019, radiotherapy combined with zoledronic acid and radiotherapy alone for bone metastasis of lung cancer were collected. Experimental studies;quality evaluation and data extraction for each of the included studies, and Cochrane risk bias assessment tools for quality evaluation of the literature. Data processing was performed using RevMan 5.3 and Stata 15.0 software, including risk ratio (OR), 95% CI, I2, and P values. Line sensitivity test, publication bias evaluation is using Egger's, Bgge's method quantitative calculation using Revman 5.3 and Stata 15.0 software for statistical analysis. Results: The total of 8 articles was included, and the number of cases was 703. The results of the meta-analysis showed that the radiotherapy, combined with the zoledronic acid group was effective in the treatment of lung cancer with bone metastasis. The meta-analysis was Z = 6.31 (P < 0.00001), OR (95% CI = 3.57, (2.41, 5.30)), the difference was statistically significant. The combined effect of bone metastases was better than that of the single-stage group. The meta-analysis results were Z = 3.18 (P = 0.001) and OR (95% CI = 3.21, (1.57, 6.59)), indicating the therapeutic effect of the two groups in the treatment of bone metastases. The difference is statistically significant. Adverse reactions include: (1) bone marrow suppression, blood toxicity;(2) fever and rash;(3) nausea, vomiting, and fatigue;(4) liver damage and loss of appetite, meta-analysis results are: bone marrow suppression, blood toxicity: Z =0.73 ( P = 0.47), OR (95% CI = 0.58 (0.13, 2.54));fever, rash: Z = 0.36 (P = 0.36), OR (95% CI = 1.3 (0.31, 5.38));nausea, vomiting, Weakness: Z = 0.29 (P = 0.77), OR (95% CI = 0.85 (0.27, 2.62));liver function damage and loss of appetite: Z = 0.00 (P = 1.00), OR (95% CI = 1.00 (0.17, 6.00)). The P values of the four meta-analyses were all greater than 0.05, and the difference was not statistically significant, indicating that the addition of zoledronic acid to the bone metastasis of lung cancer did not aggravate the changes of the above four adverse reactions. Conclusion: Radiotherapy combined with the zoledronic acid group is better than the single radiotherapy group in treating pain caused by bone metastasis. It can effectively treat bone metastasis and will not aggravate the occurrence of adverse reactions.

Anti-proliferation effect of zoledronic acid on human colon cancer line SW480

Objective: To investigate the anti-proliferation effect and mechanism of zoledronic acid(ZOL) on human colon cancer line SW480. Methods: SW480 cells were treated with 0, 12.5, 25, 50, 100 and 200 μmo L/L of ZOL for 48 h, and CCK-8 assay was employed to obtain the survival rate of SW480 cells. SW480 cells were treated with 25 μmo L/L of ZOL for 0, 12, 24, 48 and 72 h, and then the survival rate was obtained. SW480 cells of the ZOL group were treated with 25 μmo L/L of ZOL for 48 h, while cells of the Cs A+ZOL group were pretreated with 10 μmo L/L of Cs A for 0.5 h and then treated with 25 μmo L/L of ZOL for 48 h. Then the survival rates of SW480 cells of the control group, ZOL group and Cs A+ZOL group were determined. Flow cytometry was employed to detect the apoptosis rate and the mitochondrial transmembrane potential(△ψm) of the three groups and Western blot was used to detect the expressions of cyt C in the cytosol of the three groups. Results: ZOL inhibited the proliferation of SW480 cells, and the inhibition rate positively correlated with the concentration of ZOL and the action time(P< 0.01). The cell survival rate and the △ψm of the ZOL group were greatly lower than those of the control group, while the apoptosis rate and the expression of cyt C in the cytosol were obviously higher than those of the control group. All the differences showed distinctly statistical significances(P< 0.01). The cell survival rate and the △ψm of the Cs A+ZOL group were all lower than those of the control group, but substantially higher than those of the ZOL group; while the apoptosis rate and the expression of cyt C in the cytosol were higher than those of the control group, but distinctly lower than those of the ZOL group. All the differences were statistically significant(P < 0.01). Conclusions: ZOL can induce the apoptosis in human colon cancer line SW480 and then inhibit the proliferation of SW480 cells directly by opening the mitochondrial permeability transition pore abnormally, decreasing △ψm, and releasing the cyt C into the cytosol. And the effect enhances with the increases of the concentration of ZOL and the action time.

Sequential Treatment Reduces the Acute Phases of Adverse Effect of Zoledronic Acid in First Time Users

Objective: To investigate whether sequential regimen such as traditional anti-reabsorption medications followed by zoledronic acid could reduce the side effects after initiation of zoledronic acid in postmenopausal osteoporosis patients. Methods: A total of 156 postmenopausal osteoporosis patients who presented at our osteoporosis outpatient clinic were enrolled in this study. They were randomly divided into four groups: the control group, alendronate group, calcitonin group, and raloxifene group. All participants were treated with Caltrate 600 mg per day and calcitriol 0.25 ug per day as a baseline treatment, followed by administrating 5 mg/100 mL of zoledronic acid intravenously for one single time three months afterwards. During the abovementioned course of three months, the alendronate group received 70 mg of alendronate sodium orally once a week, the calcitonin group received nasal spray form of salmon calcitonin 10iu daily, the raloxifene group received 60mg of raloxifene orally daily, and the control group received nothing but only the baseline treatment. We tested parameters such as β-cross, blood calcium level, renal function both pre and post zoledronic acid treatment. We also documented those side effects that typically occurred within one week of treatment initiation, which included the proportion, severity, onset time, and duration of the fever, demand for pain medication, severity of bone and joint pain, flu-like symptoms, arrhythmia, blood calcium level, and kidney function impairment. We also evaluated how willing the patients were to receive a second dose of zoledronic acid. Then we did comparative analysis between control group and sequential group. Results: The side effects such as fever, bone and joint pain, flu-like symptoms after zoledronic acid treatment in alendronate group and calcitonin group were all significantly lower than that in control group, while raloxifene group showed no significant difference compared to that in the control group. The proportions of patients who needed NSAIDs in the alendronate group and the calcitonin group were significantly lower than that in control group. However, the raloxifene group showed no significant difference in the NSAIDs demand from that of the control group. The percentages of patients who consented to a second dose of zoledronate therapy in the alendronate, calcitonin and raloxifene groups were significantly higher than that in the control group. Conclusions: Sequential treatment with alendronate sodium or calcitonin can significantly reduce the side effects such as fever, bone/joint pain, flu-like symptoms caused by first-time zoledronic acid therapy. Raloxifene sequential treatment does not seem to have decreased or increased the side effects of zoledronic acid treatment. Also, sequential treatment can improve the patient compliance with a second dose of zoledronic acid.

Severe and Prolonged Hypocalcaemia Post Zoledronic Acid Infusion in a Patent with Sleeve Gastrectomy

Background: Zoledronic acid is commonly used to treat hypercalcaemia and osteoporosis, as well as to prevent skeletal complications from haematological and solid organ malignancies. Case presentation: We report the case of a 38 year old lady who presented with severe hypocalcaemia following the administration of zoledronic acid. Her significant background history included vitamin D deficiency and sleeve gastrectomy three years ago. She had prolonged hypocalcaemia requiring IV calcium replacement for two months. Her prolonged hypocalcaemia was attributed to her vitamin D deficiency at the time of zoledronic acid infusion as well as her history of bariatric surgery. Conclusion: This case emphasises the importance of ensuring vitamin D levels are replete prior to zoledronic acid infusion and ensuring the calcium levels are checked frequently in patients with a history of bariatric surgery obtaining zoledronic acid.

The Role of Health Education in Improving Patient Compliance with Zoledronic Acid

Objective: To define the role of health education in improving patient compliance with Zoledronic Acid for osteoporosis treatment and management and draw closer attention of patients and physicians to the importance of health education. Methods: A total of 198 postmenopausal patients with osteoporosis who were admitted by the osteoporosis outpatient clinic of our hospital and had the first administration of Zoledronic Acid in 2015 were invited to participate in the follow-up visit that involved questions concerning the frequency of health education and the questionnaire survey on osteoporosis in 2015 and the administration of Zoledronic Acid during the past three years. The patients were divided into five groups according to the frequency of health education to compare the survey results of each group in 2015 and 2018 and investigate the differences in the scores and frequency of administration among the five groups. Results: Among the 198 patients, there were 182 attending the follow-up visit. In terms of the frequency of health education (FREQ = 0, 1, 2, 3, 4), these patients were divided into five groups of 47, 63, 35, 18 and 19 members respectively. After three years of treatment, the questionnaire score of each group was higher than the pre-treatment level and the difference showed statistical significance (p Conclusion: Health education is an effective approach to influence a patient’s knowledge connected to relevant diseases in a positive way and improve patient compliance with Zoledronic Acid treatment. An enhanced health education program can be developed to assist the patients in chronic disease management.

Bone Scan Index Is a Prognostic Factor for Breast Cancer Patients with Bone Metastasis Being Treated with Zoledronic Acid

Bone scan index (BSI) has been used to quantify the spread of bone metastasis and be a prognostic indicator in prostate cancer with bone metastases. However, the utility of BSI in breast cancer patients with bone metastasis has not been yet established. We retrospectively reviewed 57 female breast cancer patients with osteoblastic/lytic combined type bone metastases and treated with zoledronic acid after bone metastasis was identified. Serial bone scintigrams were taken at the time of bone metastasis detection and during the 6- and 12-month follow-ups. The scintigrams were analyzed by BONE NAVITM version 1 and the BSI value was calculated. Additionally, serum cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) were measured. The patients were divided in 2 distinct groups—group A representing all follow-up BSI values ≤ initial BSI values and group B representing all follow-up BSI values ≥ initial BSI values. The interval changes of CA15-3 and CEA were divided in the same fashion. Kaplan-Meier method and log-rank test revealed that the overall survival rate was significantly greater in group A than those of group B after 6 months (p = 0.011) and 12 months (p = 0.016). Univariate analysis revealed that the overall survival rate was significantly greater in group A than those of group B, after a 6 month period (Hazard Ratio [HR] 5.841;95% confidence interval [CI] 1.248 - 27.34;p = 0.025) and 12 month period (HR: 4.22;95% CI 1.17615.15;p = 0.027). Multivariate analysis demonstrated that BSI changes after 6 and 12 months trended toward significance regarding parameters affecting survival rate (age and CA15-3) with a HR = 12.760 (95%CI 1.8110 - 89.850) at 6 months with a p = 0.010 and a HR = 5.0640 (95%CI 1.0590 - 24.220) at 12 months with a p = 0.042. BSI changes after 6 and 12 months appear to be a prognostic factor in breast cancer patients with bone metastasis treated with zoledronic acid.

Clinical research on zoledronic acid in treatment of pain caused by bone metastasis of malignant tumors

Objective:To evaluate the efficacy and safety of zoledronic acid for the pain caused by metastatic tumor of bone.Methods:52 patients with metastatic tumor of bone were randomly divided into two groups.The zoledronic acid group received 4 mg zoledronic acid infusion for 30 minutes and the control group received 90 mg pamidronate infusion for 6 hours. Results:The effective rates in zoledronic acid group and control group were 73.08%and 69.23%respectively.No significant difference was observed between the two groups.The median pain relief onset at days 5 and 7,respectively,and no significant difference was observed.The ECOG scores on the 7th day after medication:the differences in the zoledronic acid group before and after medication and between the two groups were both significant(P<0.001 and P=0.0448).The adverse reac- tion was no significant difference between the two groups.Conclusion:Zoledronic acid is efficient and safe in the treatment of pain caused by metastatic tumor of bone and it has low adverse reaction rate and convenient shorter using time.

Comparative study of 99Tc-MDP and zoledronic acid in the treatment of osteoporosis

Objective:To compare the efficacy and mechanism of zoledronic acid and Tc-MDP in the treatment of osteoporosis.Methods:From July 2011 to November 2015,232 patients with primary osteoporosis were selected and treated in The First Affiliated Hospital of Hainan Medical College were selected and were divided into the 116 patients in the Tc-MDP group and 116 patients in the zoledronic acid group accorded to the treatment ways.The zoledronic acid group were given zoledronic acid treatment,1 time in one year.The Tc-MDP group were given Tc-MDP treatment,and the treatment were treated for 10 days for 1 course,1 course for 3 months,and a total of 3 years of treatment were observed.The prognosis and the changes of bone mineral density and hematological parameters were recorded.Results:The total effective rates of the zoledronic acid group and Tc-MDP group were 99.1%and 90.0%,respectively,and the zoledronic acid group were significantly higher than the Tc-MDP group(P<0.05).The bone mineral density of lumbar vertebrae and hip after treatment were significantly higher than that of the two groups before treatment,and the zoledronic acid group were also significantly higher than the Tc-MDP group(P<0.05).The joint tenderness scores of the two groups were significantly lower than those before treatment,and the Tc-MDP group were also significantly lower than the zoledronic acid group(P<0.05).There were no significant differences in serum calcium and blood phosphorus levels compared between the two groups(P>0.05),and the erythroeyte sedimentation rate(ESR)levels were lower than before treatment(P<0.05),The ESR levels of the Tc-MDP group were also significantly lower than that of the zoledronic acid group(P<0.05).Conclusion:The zoledronic acid and the application of Tc-MDP in the treatment of osteoporosis can increase bone density,relieve joint tenderness symptoms,reduce ESR content,and will not affect patients'blood calcium and blood phosphorus levels.However,zoledronic acid increases bone density significantly are better than the Yunke,and Yunke relieves joint pain significantly are more than zoledronic acid.

A multicenter phase II trial of domestic product of zoledronic acid in the treatment of malignant hypercalcemia

Objective:To evaluate the effect and safety of clinical use of zoledronic acid in the treatment of malignant hypercalcemia.Methods:A multi-center,open phase II clinical trial was conducted in 15 cases with malignant hypercalcemia who received zoledronic acid intravenously for 15 min.The level of blood calcium and side effects were recorded regularly within 28 days after injection.Results:One case was dropped out due to bad compliance.The complete response rate(the corrected serum calcium was reduced to normal level)was 100.00%(14/14).The medium time of complete response rate was 5.07 days.The medium maintain time was 22.30 days.Slight,or moderate fever was observed.Conclusion:Zoledronic acid can effectively reduce the malignant hypercalcemia.The use of zoledronic acid appears to be safety and convenient.

Fall Prevention Education Reduces the Falling Rate on the Osteoporosis Patients Treated with Zoledronic Acid

Objective: Falls are one of the most common direct causes of fractures which are major causes of morbidity and mortality in osteoporosis patient. There are many factors related to falls, by interfering of fall prevention education on the patients with osteoporosis, our study is to investigate whether fall prevention education can reduce the falling rate on the osteoporosis patients treated with zoledronic acid. Methods: A total of 178 eligible female patients who first visited our osteoporosis department during January 2016 to June 2017 were invited to participate in this study, and all participants were randomly divided into an observation group (92 cases) and an intervention group (86 cases). All patients were administrated zoledronic acid once and received a questionnaire survey about factors related to falls at the beginning and a year later. The patients in the observation group only received regular orders of adopting a healthy lifestyle while those in the intervention group received fall prevention assessment and education, and a telephone follow-up and reinforced fall prevention education a month after discharge. A year later, relevant data regarding the falls of each patient of both groups during the year and the data of the questionnaire survey were collected for intergroup comparison. Results: The difference of the improvement of fall risk factors between the two groups is statistically significant (P Conclusion: For an osteoporosis patient treated with zoledronic acid, fall prevention education is an effective method to reduce the risk of falling, which would result in a lower risk of fractures and a better prognosis.

Osteonecrosis of the jaw in a patient taking once-yearly infusion of zoledronic acid for osteopenia

Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.

Zoledronic acid: 4 mg or 5 mg?

Zoledronic acid is an aminobisphosphonate that is a potent inhibitor of bone resorption.Now there are two kinds of zoledronic acid(4 mg and 5 mg)on the shelf of the pharmacy with different FDA-approved indications(antihypercalcaemia and anti-osteoporosis),which makes clinicians and pharmacists confused.Our hypothesis is that 4 mg zoledronic acid could be effective in osteoporosis patients.Theoretically,the mechanism of the anti-osteoporosis effect and anti-hypercalcaemia effect is to inhibit the osteoclasts,thus reducing the serum Ca2+concentration and improving the bone mineral density.And the anti-osteoporosis effect of zoledronic acid is dose-dependent.What’s more,some clinical trials showed that 4 mg zoledronic acid was effective in treating osteoporosis.Moreover,several clinical trials have demonstrated that zoledronic acid(4 mg)may be effective in countering bone loss resulted from aromatase inhibitor therapy or endocrine therapy.Thus maybe 4-mg dose is enough for both diseases and the 5-mg dose seems unnecessary.We just need to optimize the dosing frequency according to different conditions.

密固达(zoledronic)治疗女性绝经后及老年性骨质疏松症疗效分析

目的探讨唑来膦酸(密固达)治疗女性绝经后及老年骨质疏松症的临床疗效。方法选择120例女性绝经后及老年骨质疏松症的患者随机分为对照组及实验组,实验组应用唑来膦酸(密固达)5 mg 1年1次静滴,同时口服活性维生素D和钙剂,对照组给予平衡盐溶液1年1次,同时口服活性维生素D和钙剂1年。分别于治疗前和治疗后6个月、12个月进行骨密度测量。结果治疗后6个月骨密度稍增加(P>0.05),治疗12个月后骨密度显著升高,与对照组有显著性差异(P<0.01)。结论使用唑来膦酸预防和治疗骨质疏松,能在一定程度上抑制骨量丢失,增加骨密度,改善骨质疏松程度,降低骨折风险,提高老年骨质疏松患者的生活质量。