Background Zoledronic acid (ZOL) administered as a 5 mg intravenous infusion anually is indicated for the treatment of bone diseases such as Paget disease and osteoporosis with a high risk of fracture. It is strongly advised that patients treated with ZOL receive adequate calcium and vitamin D (calcium/vitD) supplements.
Purpose To evaluate the use of ZOL in patients with bone diseases and high risk of fractures.
Material and methods Retrospective study including all patients who started treatment with ZOL between January 2015 and July 2017. Use of ZOL and its adequacy to the recommendations was evaluated by the analysis of the following variables: pre-infusion: creatinine clearance (CrCl;MDRD) and serum calcium levels prior to administration, paratohormone levels (TPH) in cases of hypercalcaemia, previous treatment with calcium/vitD and dose adjustment in cases of hypocalcaemia; and post-infusion: ionised calcium levels and calcium/vitD dose adjustment. Sources of information: athosPRISMA™ (patient selection), Diraya-Clinical-Station (clinical reports and analytical data) and Diraya-Prescription. V5 (medical prescriptions). Statistical analysis was performed using the SPSS Statistics v.22 program.
Results One hundred and twenty-six patients were evaluated, 85.7% females (n=108), with a mean age of 67.6 years (SD: 11.3). 86.5% of patients (n=109) had previous analysis with determination of CrCl (no one with CrCl ≤35 ml/min). Previous calcium levels: not determined in 29.4% of patients (n=37), adequate in 66.7% (n=84) and needed correction in 4% (n=5): three patients with hypercalcaemia (one case did not have TPH determination and started and continued treatment with calcium/vitD supplement); two with hypocalcaemia (one case with previous calcium prescription). 40.5% of patients (n=51) received previous calcium/vitD supplements. In two patients the calcium/vitD dose was previously adjusted. Ionised calcium levels were not determined after ZOL infusion for its subsequent dose adjustment in any patient.
Conclusion Most of the patients had CrCl and serum calcium levels previously determined. However, less than half of them received prior calcium/vitD supplements. Adequate follow-up was not performed after ZOL administration. Data shows evidence of the need for adequate use of ZOL, therefore it is proposed that a protocol of use to guarantee suitability and health assistance quality of ZOL treatments should be introduced.
Reference and/or Acknowledgements 1. Int J Womens Health2010;2:353–60.
No conflict of interest
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