Osteoporosis International

, Volume 23, Issue 9, pp 2329–2333 | Cite as

Persistence with intravenous zoledronate in elderly patients with osteoporosis

  • Y.-K. Lee
  • J.-H. Nho
  • Y.-C. HaEmail author
  • K.-H. Koo
Original Article



The present study evaluates the proportion of patients who had re-infusion of intravenous zoledronate after first administration and identifies the factors that contribute to discontinuation.


In terms of persistence, annual administration of zoledronate seems to overcome a shortcoming of oral bisphosphonate. However, little information is available concerning persistence with intravenous zoledronate for osteoporosis in a usual care setting. The aim of this study was to assess the persistence of intravenous zoledronate after first administration and to identify the factors that contribute to its discontinuation.


A questionnaire survey concerning the second administration of zoledronate was performed on 259 patients, who had been administered with first intravenous zoledronate injection between January 2009 and December 2009, when they visit for second injection. The questionnaire asked whether patients were administered a second zoledronate injection or not, and non-persistent patients were asked why they declined the second infusion.


One hundred and ninety-two patients revisited our outpatient clinic a year after first visit, and 94 patients (36.3%, 94/259) agreed to a second injection. Of the 136 patients that completed the questionnaire, 47 refused second administration and requested a change to oral bisphosphonate. Thirty-nine of the 47 patients (83%) stated that post-infusion syndrome was the reason why they refused the second administration.


Although the effects of annual intravenous zoledronate are guaranteed to last for a year, this study shows that only a third of patients agree to second administration. The factors associated with discontinuation were male gender, adverse effects (especially post-infusion syndrome) and under-explanation of intravenous drug. These findings should be of concern to clinicians and indicate that patients should be informed before the administration.


Adherence Osteoporosis Persistence Treatment Zoledronate 



This study was supported by the SNU R&DB Foundation (grant no. 800-20100093).

Conflicts of interest



  1. 1.
    Seeman E, Compston J, Adachi J, Brandi ML, Cooper C, Dawson-Hughes B, Jonsson B, Pols H, Cramer JA (2007) Non-compliance: the Achilles’ heel of anti-fracture efficacy. Osteoporos Int 18:711–719PubMedCrossRefGoogle Scholar
  2. 2.
    Caro JJ, Ishak KJ, Huybrechts KF, Raggio G, Naujoks C (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008PubMedCrossRefGoogle Scholar
  3. 3.
    Compston JE, Seeman E (2006) Compliance with osteoporosis therapy is the weakest link. Lancet 368:973–974PubMedCrossRefGoogle Scholar
  4. 4.
    Boonen S, Vanderschueren D, Venken K, Milisen K, Delforge M, Haentjens P (2008) Recent developments in the management of postmenopausal osteoporosis with bisphosphonates: enhanced efficacy by enhanced compliance. J Intern Med 264:315–332PubMedCrossRefGoogle Scholar
  5. 5.
    Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031PubMedCrossRefGoogle Scholar
  6. 6.
    Kamatari M, Koto S, Ozawa N, Urao C, Suzuki Y, Akasaka E, Yanagimoto K, Sakota K (2007) Factors affecting long-term compliance of osteoporotic patients with bisphosphonate treatment and QOL assessment in actual practice: alendronate and risedronate. J Bone Miner Metab 25:302–309PubMedCrossRefGoogle Scholar
  7. 7.
    Solomon DH, Avorn J, Katz JN, Finkelstein JS, Arnold M, Polinski JM, Brookhart MA (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419PubMedCrossRefGoogle Scholar
  8. 8.
    Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRefGoogle Scholar
  9. 9.
    Kertes J, Dushenat M, Vesterman JL, Lemberger J, Bregman J, Friedman N (2008) Factors contributing to compliance with osteoporosis medication. Isr Med Assoc J 10:207–213PubMedGoogle Scholar
  10. 10.
    Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18:271–277PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnam-siSouth Korea
  2. 2.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea

Personalised recommendations