Respiratory complications associated with IV zoledronic acid infusion in the treatment of postmenopausal osteoporosis
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- Taggart, H., Cheng, J. & Archbold, P. Osteoporos Int (2010) 21: 1621. doi:10.1007/s00198-009-1088-6
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Zoledronic acid (ZA) is used to treat postmenopausal osteoporosis in a dose of 5 mgs IV annually . We report our experience in treating 30 consecutive women in 2008 with postmenopausal osteoporosis.
Thirty women mean age 71.7 years (range 50–85) with postmenopausal osteoporosis were studied.
Twenty-five (83%) were intolerant of oral bisphosphonate therapy.
Nine patients had pre-existing chest disease. Five of these had no respiratory problems post infusion. Six patients (two with pre-existing asthma and two with chronic obstructive pulmonary disease, COPD) had dyspnoea which was not present at the time of infusion but developed within 24 h. It was described by the patient as mild in three cases and moderate in two and resolved within 3 days without the need for treatment. One of these patients, a woman of 78 years with pre-existing COPD, became acutely dyspnoeic about 8 h post infusion. She was admitted to hospital with type 2 respiratory failure and spent a short time in ICU. She spent 3 weeks in hospital but eventually recovered to her pre-morbid state.
All these adverse events have been reported to the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK and Novartis.
Post-marketing surveillance is an important part of drug safety. Often, side effects are not detected in clinical trials but emerge later in clinical practise . Dyspnoea is described as “uncommon” by the manufacturers of ZA suggesting an incidence of between 1 in 100 and 1 in 1,000. We have found that it occurred in 20% of our patients, one of whom became seriously ill with type 2 respiratory failure.
The MHRA  have received 19 reports of dyspnoea and four of respiratory failure in patients given ZA.
The absence of a control group and the subjective nature of patients reporting of symptoms are possible weaknesses of this study.
In this audit, we have described dyspnoea which is a probable adverse event following closely after the administration of IV zoledronic acid. One patient was hospitalised with respiratory failure. The strong temporal association makes it likely that the infusion caused the chest symptoms. While we will have to await the experience of others, we would urge caution in using IV zoledronic acid in patients with pre-existing chronic chest disease.
Conflicts of interest
Dr. Taggart has received reimbursement for lectures from Sanofi-Aventis, Eli Lilly, Servier, Proctor& Gamble and travel expenses from Eli-Lilly and Roche.
Dr. Archbold has received reimbursement for lectures from Roche, MSD, Servier, GSK and travel expenses from Sanofi-Aventis and Takeda.
Dr. Cheng has no conflict of interest.