What can be used instead of Zoledronic acid to treat osteoporosis in a 59-year-old female?

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Fever is the most common adverse effect associated with Zoledronic acid infusion. Flu-like symptoms, such as fever, chills, bone pain, arthralgias, and myalgias, are occasionally reported but typically resolve within 24 to 48 hours and usually do not require treatment. Some other common side effects (occurring in 1% to 10% of cases) include nonspecific infections, asthenia, mucositis, chest pain, and leg edema. Zoledronic acid can also lead to renal dysfunction, resulting in Grade 3 increases (more than 3 times the upper limit of normal) in serum creatinine in 2.3% of patients, as well as blood urea increases.Uncommon side effects (0.1% to 1% incidence) include acute renal failure, hematuria, proteinuria, and pollakiuria. Very rarely (less than 0.01% of cases), uveitis, episcleritis, and iritis have been associated with zoledronic acid injection. Zoledronic acid is typically administered as a 5 mg infusion for one year in osteoporosis treatment and 4 mg for hypercalcemia. Given your previous reactions, it may be advisable to avoid its use in the future.

Alternative options like Denosumab, administered as a 6-monthly injection, can be considered. However, before starting Denosumab, it is essential to conduct tests to rule out any chronic infections like tuberculosis or hepatitis B/C. Denosumab treatment should continue for a longer duration as discontinuing it can lead to increased bone demineralization. You can also consider using Alendronic acid in tablet form. In cases where Denosumab is used sequentially, additional therapy with bisphosphonates is required 6-7 months after the last dose of Denosumab. This is important because discontinuation of Denosumab after two or more doses has been linked to rapid bone loss and the development of new vertebral compression fractures within 7-9 months after the last dose.

The primary goal of osteoporosis treatment is fracture prevention, particularly hip, vertebral, and radial fractures. Exercise, adequate calcium intake, and vitamin D (with supplementation if necessary) are suggested for individuals with osteoporosis. There are two categories of drugs used for osteoporosis management: antiresorptive drugs, which inhibit bone resorption, and anabolic drugs, which stimulate bone formation. Antiresorptive drugs include bisphosphonates, estrogen, selective estrogen receptor modulators (SERMs), calcitonin, denosumab, and romosozumab. Other options include parathyroid-like drugs.

Hope this information helps you.

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Thank you.

Hello,

Welcome back to icliniq.com.

Bisphosphonates, including Alendronate, share a similar chemical structure, which suggests a potential for cross-reactivity in immunologically mediated reactions. There have been reports of urticaria associated with bisphosphonates, and testing methods such as prick and patch testing have been documented. While cross-reactivity could be expected, desensitization or challenge procedures have been successful in establishing oral tolerance following a reaction.

In my professional opinion, the likelihood of experiencing a reaction with an oral bisphosphonate like Alendronate is lower compared to intravenous Zoledronic acid, particularly if the initial reaction did not involve urticaria or anaphylactoid-like signs and symptoms. Of course, there is also the option of considering Denosumab or other monoclonal antibodies for your treatment.

I hope this provides you with a clear perspective on your choices.

Thank you.