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Acharya PP, Joseph C. An acute phase reaction from zoledronate mimicking symptoms seen in opioid withdrawal: a case report. Addict Sci Clin Pract 2024; 19:34. [PMID: 38693547 PMCID: PMC11064307 DOI: 10.1186/s13722-024-00464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Zoledronate, a bisphosphonate, is a potent first-line treatment for osteoporosis. It is also a preferred treatment for hypercalcemia especially when unresponsive to intravenous fluids. Bisphosphonates can cause acute phase reactions that mimic opioid withdrawal symptoms, which can confound provider decision-making. Our case highlights cognitive bias involving a patient with opioid use disorder who received zoledronate for hypercalcemia secondary to immobilization and significant bone infection. CASE PRESENTATION A 41-year-old male is admitted with a past medical history of active intravenous opioid use complicated by group A streptococcal bacteremia with L5-S1 discitis and osteomyelitis, L2-L3 osteomyelitis, and left ankle abscess/septic arthritis status post left ankle washout. His pain was well-controlled by acute pain service with ketamine infusion (discontinued earlier), opioids, acetaminophen, buprenorphine-naloxone, cyclobenzaprine, gabapentin, and naproxen. Intravenous opioids were discontinued, slightly decreasing the opioid regimen. A day later, the patient reported tachycardia, diaphoresis, myalgias, and chills, which the primary team reconsulted acute pain service for opioid withdrawal. However, the patient received a zoledronate infusion for hypercalcemia, on the same day intravenous opioids were discontinued. He had no other medications known to cause withdrawal-like symptoms per chart review. Therefore, it was suspected that an acute phase reaction occurred, commonly seen within a few days of bisphosphonate use. CONCLUSION Zoledronate, well known for causing acute phase reactions, was likely the cause of withdrawal-like symptoms. Acute phase reactions with bisphosphonates mostly occur in the first infusion, and the incidence decreases with subsequent infusions. Symptoms typically occur 24-72 h post-infusion, and last at most for 72 h. Cognitive bias led the primary team to be concerned with opioid withdrawal rather than investigating other causes for the patient's presentation. Therefore, providers should thoroughly investigate potential etiologies and rule them out accordingly to provide the best care. Health care providers should also be aware of the implicit biases that potentially impact the quality of care they provide to patients.
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Affiliation(s)
- Pankti P Acharya
- Department of Anesthesiology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
| | - Crystal Joseph
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Zheng X, Ye J, Zhan Q, Zhao W, Liao Z, Ye X, Qu C. Prediction of musculoskeletal pain after the first intravenous zoledronic acid injection in patients with primary osteoporosis: development and evaluation of a new nomogram. BMC Musculoskelet Disord 2023; 24:841. [PMID: 37880626 PMCID: PMC10598955 DOI: 10.1186/s12891-023-06965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To construct a new prediction nomogram to predict the risk of musculoskeletal pain in patients with primary osteoporosis who receive zoledronic acid intravenously for the first time. METHOD Clinical data of 368 patients with primary osteoporosis who received the first intravenous injection of zoledronic acid in our hospital from December 2019 to December 2022 were studied. Patients were divided into a musculoskeletal pain group (n = 258) and a non-musculoskeletal pain group (n = 110) based on the presence or absence of musculoskeletal pain 3 days after injection. Statistically significant predictors were screened by logistic regression analysis and the minimum absolute contraction and selection operator (LASSO) to construct a nomogram. The nomogram was evaluated by the receiver operating characteristic (ROC) curve, the calibration curve, the C-index, and the decision curve analysis (DCA) and verified in a validation cohort. RESULTS The independent predictors of the nomogram were age, serum 25-hydroxyvitamin D, NSAIDs, prior Vitamin D intake, and BMI. The area under the ROC curve (AUC) was 0.980 (95% CI, 0.915-0.987), showing excellent predictive performance. The nomogram c index was 0.980, and the nomogram c index for internal verification remained high at 0.979. Moreover, calibration curves show that the nomogram has good consistency. Finally, the DCA showed that the net benefit of the nomogram was 0.20-0.49. CONCLUSION Musculoskeletal pain is a common symptom of APR in OP patients treated with intravenous zoledronic acid. Risk factors for musculoskeletal pain after zoledronic acid injection in OP patients were: non-use of NSAIDs, youth (<80 years old), serum 25 (OH) D<30ng /mL, no prior intake of vitamin D, BMI<24 kg /m2. A nomogram constructed from the above predictors can be used to predict musculoskeletal pain after the first zoledronic acid injection.
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Affiliation(s)
- Xiaoxia Zheng
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiangnan Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qunzhang Zhan
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weifeng Zhao
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No.261, Longxi Avenue, Guangzhou, 510000, Guangdong, China
| | - Zhongqin Liao
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaolin Ye
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chongzheng Qu
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No.261, Longxi Avenue, Guangzhou, 510000, Guangdong, China.
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Wang H, Liu Q, Jiang M, Song C, Liu D. Optimization of the dosage regimen of zoledronic acid with a kinetic-pharmacodynamic model and exposure-response analysis. Front Pharmacol 2023; 14:1089774. [PMID: 37829305 PMCID: PMC10565503 DOI: 10.3389/fphar.2023.1089774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/04/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose: In order to support the dose optimization of zoledronic acid, the kinetic-pharmacodynamic model and exposure-response analysis were used to describe the changes in bone mineral density in different doses of zoledronic acid and establish the relationship between dose and acute phase reaction. Methods: Data were extracted from literature in accessible public databases. The kinetic-pharmacodynamic model was developed based on the above data using the NONMEM package to estimate parameters describing the relationship between the dose of zoledronic acid and bone mineral density. Exposure-response analysis was developed to establish the relationship between dose and acute phase reaction. Model evaluation was performed using goodness-of-fit, coefficient of variation (CV%). And sensitivity analyses were performed to assess the necessity of related parameters. Then the established model was used to simulate the changes of bone mineral density under different administration regimens, and the literature data was verified. Results: The kinetic-pharmacodynamic model successfully described zoledronic acid dose and change of bone mineral density in osteoporosis patients, with coefficient of variation of most less than 71.5%. The exposure-response analysis showed the incidence of acute phase reaction is dose-dependent. The bone mineral density was simulated based on the developed kinetic-pharmacodynamic model. And the simulated change of bone mineral density and the incidence of acute phase reaction could be helpful to propose a dosage regimen. Conclusion: Overall, the kinetic-pharmacodynamic model described changes of bone mineral density in different doses of zoledronic acid in vivo. And, the model and the exposure-response analysis also showed to provide the assessment of dose-response relationship for zoledronic acid.
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Affiliation(s)
- Huan Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital Beijing, Beijing, China
| | - Qi Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital Beijing, Beijing, China
| | - Muhan Jiang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital Beijing, Beijing, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital Beijing, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital Beijing, Beijing, China
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Takada J, Sato S, Arai K, Kito Y, Oshita Y, Saito K. Safety and effectiveness of once-yearly zoledronic acid in Japanese osteoporosis patients: three-year post-marketing surveillance. J Bone Miner Metab 2023; 41:268-277. [PMID: 36862212 PMCID: PMC9978276 DOI: 10.1007/s00774-023-01410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Zoledronic acid (5 mg; ZOL), a once-yearly bisphosphonate, reduces osteoporotic fractures and increases bone mineral density (BMD). This 3-year post-marketing surveillance examined its real-world safety and effectiveness. MATERIALS AND METHODS This prospective, observational study included patients who started ZOL for osteoporosis. Data were assessed at baseline, 12, 24, and 36 months for safety and effectiveness. Treatment persistence, potentially related factors, and persistence before and after the COVID-19 pandemic started were also investigated. RESULTS The safety analysis and effectiveness analysis sets included 1406 and 1387 patients, respectively, with mean age of 76.5 years. Adverse reactions (ARs) occurred in 19.35% of patients, with an acute-phase reaction in 10.31, 1.01, and 0.55% after the first, second, and third ZOL infusions. Renal function-related ARs, hypocalcaemia, jaw osteonecrosis, and atypical femoral fracture occurred in 1.71, 0.43, 0.43, and 0.07% of patients, respectively. Three-year cumulative fracture incidences were 4.44% for vertebral, 5.64% for non-vertebral, and 9.56% for clinical fractures. BMD increased by 6.79, 3.14, and 1.78% at the lumbar spine, femoral neck, and total hip, respectively, after 3-year treatment. Bone turnover markers remained within reference ranges. Treatment persistence was 70.34% over 2 years and 51.71% over 3 years. Male, age ≥ 75 years, no previous medicines for osteoporosis, no concomitant medicines for osteoporosis, and inpatient at the first infusion were related to discontinuation. There was no significant difference in the persistence rate between before and after the COVID-19 pandemic (74.7% vs. 69.9%; p = 0.141). CONCLUSION This 3-year post-marketing surveillance confirmed the real-world safety and effectiveness of ZOL.
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Affiliation(s)
- Junichi Takada
- Osteoporosis Center, Sapporo Kotoni Orthopaedics, 1-30 Kotoni 4-4, Nishi-Ku, Sapporo, Hokkaido, 063-0814, Japan
- Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-Ku, Sapporo, Hokkaido, 002-8072, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shizu Sato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Kouichi Arai
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Yoriko Kito
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Yuko Oshita
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Kazuko Saito
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan.
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Kuo B, Koransky A, Vaz Wicks CL. Adrenal Crisis- An Adverse Reaction to Zoledronic Acid in a Patient with Primary Adrenal Insufficiency: A Case Report and Literature Review. AACE Clin Case Rep 2022; 9:32-34. [PMID: 37056413 PMCID: PMC10086596 DOI: 10.1016/j.aace.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background/Objective Adrenal crisis is a medical emergency and an acute complication of adrenal insufficiency (AI). It can be triggered by stressors such as infection, dehydration, trauma, or surgery. Case Report We present a case of a 70-year-old woman with a history of Addison's disease, who presented in adrenal crisis within 24 hours after receiving her first infusion of zoledronic acid. No trigger was identified after extensive evaluation, making infusion with zoledronic acid the most likely cause of adrenal crisis. Discussion Adverse reactions to medications can potentially trigger adrenal crisis. The present case report demonstrates that intravenous bisphosphonates can cause an acute phase reaction that may lead to adrenal crisis. Given the increased risk of osteoporosis in patients with AI there is an increased likelihood of prescription of intravenous bisphosphonates in this patient population. Conclusion Patients with AI undergoing infusion with zoledronic acid may require an increased dose of glucocorticoid prior to infusion and may need to undergo monitoring post infusion for possible adrenal crisis.
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Lu K, Shi Q, Gong YQ, Shao JW, Li C. Predicting the acute-phase response fever risk in bisphosphonate-naive osteoporotic patients receiving their first dose of zoledronate. Osteoporos Int 2022; 33:2381-2396. [PMID: 35920895 DOI: 10.1007/s00198-022-06493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION To devise a precise and efficient tool for predicting the individualized risk of acute-phase response (APR) in bisphosphonate (BP)-naive osteoporotic (OP) patients, receiving their first intravenous dose of zoledronate (ZOL). METHODS The baseline clinical and laboratory data of 475 consecutive BP-naive OP patients, who received their first intravenous dose of ZOL between March 2016 and March 2021 in the Affiliated Kunshan Hospital of Jiangsu University, were chosen for analysis. Univariate and multivariable logistic regression models were generated to establish candidate predictors of APR fever risk, using three distinct fever thresholds, namely, 37.3 °C (model A), 38.0 °C (model B), and 38.5 °C (model C). Next, using predictor regression coefficients, three fever-threshold nomograms were developed. Discrimination, calibration, and clinical usefulness of each predicting models were then assessed using the area under the curve (AUC), calibration curve (CC), and decision curve analysis (DCA). The internal and external model validations were then performed. RESULTS The stable predictors were age, serum 25-hydroxy vitamin D, serum total calcium, and peripheral blood erythrocytes count. These were negatively associated with the APR fever risk. The AUCs of models A, B, and C were 0.828 (95% confidence intervals [CI], 0.782 to 0.874), 0.825 (95% CI, 0.767 to 0.883), and 0.879 (95% CI, 0.824 to 0.934), respectively. Good agreement was observed between the predictions and observations in the CCs of all three nomograms. CONCLUSIONS This study developed and validated nomogram prediction models that can predict APR fever risk in BP-naive OP patients receiving their first infusion of ZOL.
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Affiliation(s)
- Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Gusu School, Nanjing Medical University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - Qin Shi
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, 215031, Jiangsu, China
| | - Ya-Qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Gusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China
| | - Jia-Wei Shao
- Product R & D Department, Shanghai Fosun Health Technology Group Co Ltd, Shanghai, 200030, China
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Gusu School, Nanjing Medical University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China.
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Evaluation of intravenous zoledronic acid-induced acute-phase response in the emergency department. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1036910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: A temporary influenza-like condition, called acute-phase reaction (APR), is commonly observed with intravenous (IV) administration of nitrogen-containing amino bisphosphonates, such as zoledronic acid (ZOL). This single-center study aimed to evaluate the incidence of APR symptoms after intravenous (IV) ZOL administration in patients with postmenopausal osteoporosis who were admitted to emergency department (ED).
Methods: In this cross-sectional study, 107 osteoporotic patients who were diagnosed with post-menopausal osteoporosis (bone mineral density T-score equal to or below −2.5 with/without prevalent fractures) and who had an ED admission in the first 72 h after intravenous injection of ZOL were included in the study. The patient’s pre-treatment blood sample measurements, presenting symptoms (such as fever, fatigue, hyperpyrexia, headache), family history, previous medical treatment, and adverse effects caused by osteoporosis drugs, in addition to information on co-morbidities and comedications were obtained from clinical records.
Results: One-hundred seven osteoporotic patients (19.56%) patients experienced APR and were admitted to the ED after IV-ZOL administration. The mean age was 64.58 (11.15) years (n = 107). The three most commonly reported symptoms were diffuse musculoskeletal symptoms, influenza-like illness, and gastrointestinal symptoms (34.5%, 21.5%, and 18.5%, respectively). Seventy percent of the patients who presented to the ED with APR symptoms were prescribed drugs only, and 30% of the patients received treatment specific for their symptoms in the ED. Most of the diffuse musculoskeletal symptoms consisted of myalgia (22.4%). A positive correlation between the onset time of APR symptoms and the number of IV bisphosphonate (BP) doses was found (r = 0.597; P = 0.032).
Conclusion: Our study indicates that as the number of IV-ZOL administrations increase yearly in patients with osteoporosis, symptom onset time occurs later. A linear relationship was found between the number of drug applications and the duration of symptoms. Also, the incidence of APR following IV-ZOL administration was 19% in the osteoporotic patient population who presented to the ED or to other clinics according to the symptoms.
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Liu Q, Han G, Li R, Fan D, Du G, Zhang M, Tao L, Li H, Liu D, Song C. Reduction effect of oral pravastatin on the acute phase response to intravenous zoledronic acid: protocol for a real-world prospective, placebo-controlled trial. BMJ Open 2022; 12:e060703. [PMID: 35831045 PMCID: PMC9280907 DOI: 10.1136/bmjopen-2021-060703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Zoledronic acid (ZA) has been used as a first-line treatment in patients with osteoporosis (OP) who receive an annual injection of 5 mg. However, side effects of bone pain and fever, known as the acute phase response (APR), have often been observed after clinical usage. A meta-analysis reported that the incidence of APR was 49.4% among patients with OP who received ZA for the first time and that 30% of patients with these adverse effects refused treatment in the following year. As a clinically used hypolipidaemic drug, statins can inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase to block the pathway upstream of farnesyl pyrophosphate synthase. This process can decrease the accumulation of isopentenyl pyrophosphate to prevent γδT-cell activation and inflammatory factor production, blocking APR occurrence. The aim of this study is to determine the reduction effect of oral pravastatin on APR and investigate the possible mechanisms underlying the effect in vivo. METHODS AND ANALYSIS This will be a single-centre, placebo-controlled trial. Female participants will be allocated at a 1:1 ratio to receive either oral pravastatin or a placebo at 1-hour predose and 24 and 48 hours post-administration of ZA. The primary outcome will be the incidence of APR within 72 hours after ZA infusion. The secondary outcomes will include the occurrence time and severity of APR and the frequency and amount of acetaminophen usage within 72 hours after ZA infusion. This study will determine the preventive effect of oral pravastatin on APR in Chinese patients with OP, supporting the clinical application of ZA to alleviate concerns regarding safety and increase patient compliance. ETHICS AND DISSEMINATION This study protocol has been registered with ClinicalTrials.gov. This study protocol was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee. The results will be published in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04719481.
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Affiliation(s)
- Qi Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Runting Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Dongwei Fan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Guohong Du
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Min Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Chunli Song
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Lu K, Shi Q, Gong YQ, Li C. Association between vitamin D and zoledronate-induced acute-phase response fever risk in osteoporotic patients. Front Endocrinol (Lausanne) 2022; 13:991913. [PMID: 36299453 PMCID: PMC9589500 DOI: 10.3389/fendo.2022.991913] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To elucidate the independent correlation between vitamin D content and zoledronate (ZOL)-triggered acute-phase response (APR) fever risk in osteoporotic (OP) patients, and to examine the potential threshold for optimal vitamin D concentrations that prevent the occurrence of ZOL-induced fever. METHODS This retrospective investigation was based on a prospectively documented database compiled at the Affiliated Kunshan Hospital of Jiangsu University between January 2015 and March 2022. In total, 2095 OP patients, who received ZOL during hospitalization, were selected for analysis. The primary endpoint was the presence (>37.3°C) or absence (≤37.3°C) of fever, quantified by the maximum body temperature, measured within 3 days of ZOL infusion. The exposure variable was the baseline serum 25-hydroxyvitamin D (25[OH]D) levels. RESULTS The OP patients with fever exhibited markedly reduced 25(OH)D content than those without fever. Upon adjusting for age, gender, order of infusion of ZOL, main diagnosis, season of blood collection, year of blood collection, calcitonin usage, and beta-C-terminal telopeptide of type I collagen (β-CTX) levels, a 10 ng/mL rise in serum 25(OH)D content was correlated with a 14% (OR, 0.86; 95% CI, 0.76 to 0.98, P-value = 0.0188) decrease in the odds of ZOL-induced fever. In addition, a non-linear relationship was also observed between 25(OH)D levels and fever risk, and the turning point of the adjusted smoothed curve was 35 ng/mL of serum 25(OH)D content. CONCLUSIONS Herein, we demonstrated the independent negative relationship between serum 25(OH)D content and ZOL-induced fever risk. According to our analysis, 25(OH)D above 35 ng/mL may be more effective in preventing ZOL-induced APR. If this is confirmed, a "vitamin D supplemental period" is warranted prior to ZOL infusion, particularly the first ZOL infusion, to ensure appropriate 25(OH)D levels that protect against ZOL-induced fever.
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Affiliation(s)
- Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
- Department of Orthopedics, Gusu School, Nanjing Medical University, Suzhou, China
| | - Qin Shi
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, China
| | - Ya-qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
- *Correspondence: Chong Li,
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Characteristics Associated with Acute-Phase Response following First Zoledronic Acid Infusion in Brazilian Population with Osteoporosis. J Osteoporos 2021; 2021:9492883. [PMID: 35003621 PMCID: PMC8731262 DOI: 10.1155/2021/9492883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to evaluate characteristics associated with acute-phase response (APR) following first zoledronic acid infusion in a Brazilian cohort. This retrospective cohort study enrolled all adults with osteoporosis who underwent a first zoledronic acid infusion at our centre between June 2015 and June 2019. Clinical demographics (age, sex, diabetes, smoking, body mass index, and previous oral bisphosphonate use) and laboratory data (calcium, parathyroid hormone, renal function, and serum 25-hydroxyvitamin D and carboxy-terminal crosslinked telopeptide of type 1 collagen [CTX], both before and after infusion) were compared between patients with and without APR. We evaluated association magnitude between the presence of APR and clinical variables through logistic regression. This study enrolled 400 patients (women, 80%). APR was observed in 24.5% (n = 98) of patients. The mean symptom duration in days was 3.5 ± 2.8. Patients with APR were younger (67 ± 12 vs. 71 ± 11 years; p=0.001), used oral bisphosphonates less frequently (34% × 50%; p=0.005), and had greater baseline CTX (0.535 ng/mL [0.375, 0.697] × 0.430 [0.249, 0.681]; p=0.03) and ΔCTX (-69 [-76; -50] × -54 [-72; -23]; p=0.002) than those without APR. The other variables were similar between the groups. Only ΔCTX was associated (OR, 0.62; 95% CI 0.41-0.98) with APR after accounting for age and bisphosphonate use. APR occurred in 24.5% of the cohort. Younger age and absence of prior oral bisphosphonate use were associated with APR following first zoledronic acid infusion. APR was associated with ΔCTX (but no other variables) after adjusting for these factors.
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Takada J, Iba K, Yamamoto O, Dohke T, Saito A, Yamamura M, Takebayashi T, Akatsuka T, Yamashita T. Early adverse events after the first administration of zoledronic acid in Japanese patients with osteoporosis. J Bone Miner Metab 2021; 39:903-910. [PMID: 33988758 DOI: 10.1007/s00774-021-01231-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The occurrence of early adverse events and the factors associated with these events in zoledronic acid-treated Japanese patients with osteoporosis were investigated. MATERIALS AND METHODS All patients treated with zoledronic acid for the first time for primary osteoporosis were analyzed. Based on the history of bisphosphonate (BP) administration, the patients were divided into three groups: BP-switch, BP-washout, and naïve groups. The BP-washout and naive groups were combined into a non-BP group. RESULTS A total of 184 patients with a mean age of 77.4 years were included. Acute phase reactions (APRs) occurred in 32 patients (17.4%). The significant risk factors were hospitalization (vs. outpatients), BP-switch (vs. non-BP), and age > 80 years (vs. ≤ 69 years), and the odds ratios were 5.63, 0.12, and 0.23, respectively. The serum calcium levels were significantly reduced in the non-BP group, regardless of the co-administration of active vitamin D3. However, the patients who were co-administered active vitamin D3 had significantly higher values than those who were not. In the BP-switch group, no significant reduction in serum calcium levels was observed; however, the reductions tended to be smaller in the patients who were co-administered active vitamin D3. CONCLUSION Occurrence of APRs might be lesser in clinical practice than in phase 3 clinical trials. Although serum calcium levels decreased in many cases, the decrease could be suppressed by the co-administration of active vitamin D3.
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Affiliation(s)
- Junichi Takada
- Osteoporosis Center, Sapporo Kotoni Orthopaedic, 1-30 Kotoni 4-4, Nishi-ku, Sapporo, Hokkaido, 063-0814, Japan.
- Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-ku, Sapporo, Hokkaido, 002-8072, Japan.
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Osamu Yamamoto
- Ebetsu Yamamoto Orthopedics, 3-3, Takasago-cho, Ebetsu, Hokkaido, 067-0074, Japan
| | - Takayuki Dohke
- Do-Clinic Orthopaedic/Musculoskeletal Rehabilitaion, 291-81, S-1, W-14, Chuo-ku, Sapporo, Hokkaido, 060-0061, Japan
| | - Akira Saito
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
- Department of Orthopaedic Surgery, Chitose City Hospital, 2-1-1, Hokko, Chitose, Hokkaido, 066-8550, Japan
| | - Megumu Yamamura
- Sapporo Maruyama Orthopedic Hospital, 1-3, N-7, W-27, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan
| | - Tsuneo Takebayashi
- Sapporo Maruyama Orthopedic Hospital, 1-3, N-7, W-27, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan
| | - Tomohiro Akatsuka
- Osteoporosis Center, Sapporo Kotoni Orthopaedic, 1-30 Kotoni 4-4, Nishi-ku, Sapporo, Hokkaido, 063-0814, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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12
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Nakamura Y, Shimizu T, Asano T, Shimodan S, Ishizu H, Takahashi D, Takahata M, Iwasaki N. Short-term efficacy and safety of zoledronate acid or denosumab in Japanese patients with postmenopausal osteoporosis. J Bone Miner Metab 2021; 39:824-832. [PMID: 33821302 PMCID: PMC8021003 DOI: 10.1007/s00774-021-01221-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to compare the efficacy after switching from either bisphosphonates (BPs) or non-BPs (NBPs) to combination therapies of denosumab (DMAb) or zoledronic acid (Zol) with eldecalcitol (ELD) in bone mineral density (BMD) and bone metabolism and investigate the prognostic and risk factors of side effects of this therapy. MATERIALS AND METHODS One-hundred forty-eight patients with postmenopausal osteoporosis were recruited; their therapy was switched from BPs or NBPs to Zol or DMAb plus ELD (BP-Zol: 43, NBP-Zol: 32, BP-DMAb: 35, and NBP-DMAb: 38). Longitudinal changes in bone metabolic markers (P1NP and TRACP-5b) and BMD were evaluated. RESULTS In the BP-Zol group, P1NP did not change after 6 months and increased by 38.9% after 12 months. TRACP-5b decreased 15.8% after 6 months, but came back to baseline values 12 months after administration. In the rest of the groups, the bone metabolic markers remained suppressed after 6 and 12 months. Compared with baseline, all groups showed increase in BMD after 6 and 12 months. Bone metabolic markers at baseline were correlated with %change in lumbar spine BMD from baseline to 12 months. P1NP and 25-hydroxy vitamin D levels at baseline were identified as potential predictors of development of acute-phase reactions. CONCLUSIONS The combination therapy of Zol or DMAb and ELD may increase BMD at 12 months after the first administration in Japanese patients with postmenopausal osteoporosis, regardless of BPs pretreatment. Bone metabolic markers at baseline may be useful predictors for reaction to the therapy and side effects caused by these combination therapies in postmenopausal osteoporosis.
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Affiliation(s)
- Yumejiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shun Shimodan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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13
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Kong SH, Hwang BK, Yoon BH. The Impact of COVID-19 on the Optimal Management of Osteoporosis. J Bone Metab 2021; 28:115-122. [PMID: 34130363 PMCID: PMC8206610 DOI: 10.11005/jbm.2021.28.2.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone’s lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people’s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Kwon Hwang
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
| | - Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
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14
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Diana A, Carlino F, Giunta EF, Franzese E, Guerrera LP, Di Lauro V, Ciardiello F, Daniele B, Orditura M. Cancer Treatment-Induced Bone Loss (CTIBL): State of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy. Curr Treat Options Oncol 2021; 22:45. [PMID: 33864145 PMCID: PMC8052225 DOI: 10.1007/s11864-021-00835-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT About 70-80% of early breast cancer (BC) patients receive adjuvant endocrine therapy (ET) for at least 5 years. ET includes in the majority of cases the use of aromatase inhibitors, as upfront or switch strategy, that lead to impaired bone health. Given the high incidence and also the high prevalence of BC, cancer treatment-induced bone loss (CTIBL) represents the most common long-term adverse event experimented by patients with hormone receptor positive tumours. CTIBL is responsible for osteoporosis occurrence and, as a consequence, fragility fractures that may negatively affect quality of life and survival expectancy. As recommended by main international guidelines, BC women on aromatase inhibitors should be carefully assessed for their fracture risk at baseline and periodically reassessed during adjuvant ET in order to early detect significant worsening in terms of bone health. Antiresorptive agents, together with adequate intake of calcium and vitamin D, should be administered in BC patients during all course of ET, especially in those at high risk of osteoporotic fractures, as calculated by tools available for clinicians. Bisphosphonates, such as zoledronate or pamidronate, and anti-RANKL antibody, denosumab, are the two classes of antiresorptive drugs used in clinical practice with similar efficacy in preventing bone loss induced by aromatase inhibitor therapy. The choice between them, in the absence of direct comparison, should be based on patients' preference and compliance; the different safety profile is mainly related to the route of administration, although both types of drugs are manageable with due care, since most of the adverse events are predictable and preventable. Despite advances in management of CTIBL, several issues such as the optimal time of starting antiresorptive agents and the duration of treatment remain unanswered. Future clinical trials as well as increased awareness of bone health are needed to improve prevention, assessment and treatment of CTIBL in these long-term survivor patients.
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Affiliation(s)
- Anna Diana
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy.
- Medical Oncology Unit, Ospedale del Mare, 80147, Naples, Italy.
| | - Francesca Carlino
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Emilio Francesco Giunta
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Elisena Franzese
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Luigi Pio Guerrera
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Vincenzo Di Lauro
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
| | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147, Naples, Italy
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131, Naples, Italy
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15
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Zhu K, Zhang J, Zhang C, Zhao Z, Gao J, Li X, Xia X, Xu X, Zhang T, Guan J. Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture. Osteoporos Int 2021; 32:559-564. [PMID: 32989470 DOI: 10.1007/s00198-020-05637-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Zoledronic acid could improve the clinical outcome in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture in the 1-year prospective study. INTRODUCTION To validate the therapeutic efficacy of zoledronic acid (ZOL) in elderly patients with femoral neck fracture who received total hip arthroplasty (THA) or hemiarthroplasty (HA). METHODS Included in this study were 95 elderly patients with femoral neck fractures who received THA/HA between August 2015 and June 2018. They were randomized into a ZOL group and a control group. Patients in ZOL group received a yearly single dose of 5 mg ZOL intravenous injection plus 0.5 μg/day calcitriol and 1000 mg/day calcium carbonate 2 days before THA or HA. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate only without ZOL. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Bone metabolism markers including the total extension of the peptide type I collagen amino end (P1NP) and beta collagen degradation product (β-CTX) were obtained by serum examination. The postoperative functional outcome was assessed using Harris Hip Score (HHS). RESULTS During the follow-up period, BMD in the ZOL group was improved and significantly higher than that in the control group at 6 and 12 months post-operation. Bone metabolism markers P1NP and β-CTX in ZOL group remained at a relatively low level as compared with that in the control group at 6 months after treatment. No significant difference in the mean HHS and the excellent/good rate of joint function was observed during the follow-up period between the two groups. The occurrence of adverse events in the ZOL group was significantly higher than that in the control group. CONCLUSIONS A single infusion of ZOL shows promise in improving BMD of the healthy side of the femoral neck, lumbar spine, and total hip and decreasing the level of bone markers, which may improve the clinical outcome of patients with osteoporotic femoral neck fractures receiving THA/HA.
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Affiliation(s)
- K Zhu
- Jinan University, Guangzhou, China
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Zhang
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - C Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Z Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Gao
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Li
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xia
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xu
- Department of Rheumatology, Changhai Hospital, Shanghai, China.
| | - T Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - J Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
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16
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Giusti A, Camellino D, Saverino D, Iervasi E, Girasole G, Bianchi G, Papapoulos SE. Zoledronate decreases CTLA-4 in vivo and in vitro independently of its action on bone resorption. Bone 2020; 138:115512. [PMID: 32603908 DOI: 10.1016/j.bone.2020.115512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
Acute phase response (APR) following intravenous zoledronate (ZOL) administration is related to activation and increased proliferation of γδ T cells, attributed to the molecular mechanism of action of nitrogen-containing bisphosphonates (N-BPs). ZOL, however, has also been reported to inhibit the proliferation of regulatory T cells in vitro and to reduce the expression of Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4), a negative regulator of T cell activation that is increased in patients with autoimmune diseases. There are, however, no data on the relationship between ZOL treatment and soluble(s)CTLA-4 either in vivo in relevant patient populations or in vitro with the use of assays relevant to the mechanism of action of N-BPs. The objectives of the present study were firstly, to characterize the ZOL-induced APR in patients with inflammatory rheumatic diseases (IRDs) and its relationship with changes in circulating sCTLA-4 and secondly, to investigate the effects of ZOL on CTLA-4 production and expression by peripheral blood mononuclear cells (PBMCs). We studied 10 postmenopausal women with IRDs treated with intravenous ZOL 5 mg. Five women experienced APR (APR+) associated with significant decreases in blood lymphocytes and increases in granulocytes and serum CRP. Serum sCTLA-4 values were increased in all patients before ZOL administration and decreased significantly 72 h after the ZOL infusion (from 30.0 ± 2.9 to 6.3 ± 1.8 ng/ml; p < 0.001) with no differences between APR+ and APR- patients. Consistent with the results of the in vivo study, ZOL (1 μM) decreased the production of sCTLA-4 by 87% and 57% after 3 and 5 days in cultures of peripheral blood mononuclear cells (PBMCs) in vitro, respectively, and inhibited the expression of both cytoplasmic and membrane-bound CTLA-4. Our results reveal a novel immunoregulatory action of ZOL that is not related to its action on bone resorption but might be associated with reported clinically significant extraskeletal outcomes of ZOL treatment.
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Affiliation(s)
- Andrea Giusti
- Rheumatology Unit, Department of Musculoskeletal System, Local Health Trust 3, Via Missolungi 14, 16147 Genoa, Italy.
| | - Dario Camellino
- Rheumatology Unit, Department of Musculoskeletal System, Local Health Trust 3, Via Missolungi 14, 16147 Genoa, Italy
| | - Daniele Saverino
- Laboratory of Autoimmunology, Department of Experimental Medicine, University of Genoa, Via De Toni 14, 16132 Genoa, Italy
| | - Erika Iervasi
- Laboratory of Autoimmunology, Department of Experimental Medicine, University of Genoa, Via De Toni 14, 16132 Genoa, Italy
| | - Giuseppe Girasole
- Rheumatology Unit, Department of Musculoskeletal System, Local Health Trust 3, Via Missolungi 14, 16147 Genoa, Italy
| | - Gerolamo Bianchi
- Rheumatology Unit, Department of Musculoskeletal System, Local Health Trust 3, Via Missolungi 14, 16147 Genoa, Italy
| | - Socrates E Papapoulos
- Rheumatology Unit, Department of Musculoskeletal System, Local Health Trust 3, Via Missolungi 14, 16147 Genoa, Italy; Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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17
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Abstract
As the world grapples with the crisis of COVID-19, established economies and healthcare systems have been brought to their knees. Tough decisions regarding redirection of resources away from the management of conditions deemed "nonessential" are being made. How can we balance urgent resourcing of our acute crisis while not abandoning the real need of patients with osteoporosis? This article offers a few practical solutions.
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Affiliation(s)
- C M Girgis
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, Sydney, Australia.
- Department of Endocrinology and Diabetes, Westmead Hospital, Westmead, Sydney, Australia.
| | - R J Clifton-Bligh
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, Sydney, Australia
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18
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Upadhyaya GK, Iyengar K, Jain VK, Vaishya R. Challenges and strategies in management of osteoporosis and fragility fracture care during COVID-19 pandemic. J Orthop 2020; 21:287-290. [PMID: 32523258 PMCID: PMC7265833 DOI: 10.1016/j.jor.2020.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
Background COVID-19 has resulted in restriction of face to face consultations and mechanisms to access health care. Osteoporosis and fragility fractures forms a significant proportion of adult trauma and orthopaedic workload even during the pandemic. Aims We assess the challenges and strategies used in the management of osteoporosis and fragility fracture care during the COVID-19 pandemic. Methods We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 on developments and guidance during the current COVID-19 pandemic. Results Osteoporosis and fragility fractures management has been hampered by lock down and infection transmission strategies used to contain the COVID-19 pandemic. Access to diagnostic tests, treatment facilities with the need to use clinical and prediction tools to guide management Telemedicine has an evolving role. Conclusion Osteoporosis and fragility fractures in elderly individuals pose a real challenge for an appropriate diagnosis and management, during the COVID-19 pandemic. A clinical decision along with use of clinical prediction tools for osteoporosis should be used to direct treatment. Obligatory fractures such as hip fractures require operative intervention. Non-obligatory fractures such as distal radius fractures can be managed conservatively with use of telemedicine applications in monitoring both types of patients.
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Affiliation(s)
- Gaurav K. Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Rae Bareli, UP, India
| | | | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author.
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
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19
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Fazmin IT, Huang CLH, Jeevaratnam K. Bisphosphonates and atrial fibrillation: revisiting the controversy. Ann N Y Acad Sci 2020; 1474:15-26. [PMID: 32208537 DOI: 10.1111/nyas.14332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
Bisphosphonates (BPs) are widely prescribed drugs used to treat osteoporosis, commonly arising in postmenopausal women and in chronic glucocorticoid use. Their mechanism of action is through inhibiting osteoclast-induced bone remodeling, and they also possess calcium sequestering properties. Common side effects involve the gastrointestinal system and rare but serious side effects, including osteonecrosis of the jaw. However, a link between BPs and atrial fibrillation (AF) has been proposed, with early clinical trials, such as the Fracture Intervention Trial and the HORIZON Pivotal Fracture Trial, reporting that BPs are associated with increased risk of AF. Nevertheless, subsequent studies have reported contrasting results, ranging from no effect of BPs to antiarrhythmic effects of BPs. Preclinical and electrophysiological studies on any proarrhythmic effect of BPs are limited in scope and number, but suggest possible mechanisms that include antiangionesis-related myocardial remodeling, calcium handling abnormalities, and inflammatory changes. Contrastingly, some studies indicate that BPs are antiarrhythmic by inhibiting fibrotic myocardial remodeling. In order to continue established clinical prescribing of BPs within absolute margins of safety, it will be necessary to systematically rule in/rule out these mechanisms. Thus, we discuss these studies and examine in detail the potential mechanistic links, with the aim of suggesting further avenues for research.
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Affiliation(s)
- Ibrahim T Fazmin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Cambridge, United Kingdom.,Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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20
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Okimoto N, Sakai A, Yoshioka T, Kobayashi T, Asano K, Akahoshi S, Ishikura T, Fukuhara S, Fuse Y, Mizuno T, Katae Y, Matsumoto H, Ogawa T, Nishida S, Ikeda S, Menuki K, Saito J, Okazaki Y, Mizuno N, Fujiwara S. Efficacy of non-steroidal anti-inflammatory drugs on zoledronic acid-induced acute-phase reactions: randomized, open-label, Japanese OZ study. J Bone Miner Metab 2020; 38:230-239. [PMID: 31586241 DOI: 10.1007/s00774-019-01050-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Zoledronic acid infusion is used to treat osteoporosis but patients, especially Japanese patients, often experience acute-phase reactions (APRs). In this multicenter, randomized, open-label, parallel-group study, we examined the efficacy of the most commonly used non-steroidal anti-inflammatory drug loxoprofen in Japan in reducing the incidence rate of zoledronic acid-induced APRs and body temperature, and investigated risk/protective factors for APRs in this population. MATERIALS AND METHODS Patients aged ≥ 60 years with primary osteoporosis (n = 368) were allocated randomly to zoledronic acid plus loxoprofen (ZOL + LOX) or zoledronic acid alone (ZOL). All patients received 5-mg zoledronic acid infusion on day 1, and patients in the ZOL + LOX group also received 120 mg and 180 mg of oral loxoprofen on days 1 and 2, respectively. Adverse events and body temperature were recorded during the 7-day observation period. RESULTS The incidence rates of APRs were 34.4% (64/186 patients) and 47.8% (87/182 patients) in the ZOL + LOX and ZOL groups, respectively (P = 0.0109). The proportions of patients with increased body temperature (≥ 1 °C and ≥ 37.5 °C) were similar in both groups (P = 0.1186). Past bisphosphonate users had a significantly lower incidence rate of APRs than treatment-naïve patients (odds ratio 0.444, 95% confidence interval 0.285-0.692, P = 0.0003). CONCLUSIONS Zoledronic acid-induced APRs appeared to be suppressed by loxoprofen. Known risk/protective factors, including prior osteoporosis treatment, were applicable to Japanese patients.
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Affiliation(s)
- Nobukazu Okimoto
- Okimoto Clinic, 185-4 Kubi, Yutaka-machi, Kure, Hiroshima, 734-0304, Japan.
| | - Akinori Sakai
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, 807-8555, Japan
| | - Toru Yoshioka
- Department of Orthopedic Surgery, Shimura Hospital, 3-13 Funairimachi, Naka-ku, Hiroshima, 730-0841, Japan
| | - Tomohiro Kobayashi
- Department of Orthopedic Surgery, Shimura Hospital, 3-13 Funairimachi, Naka-ku, Hiroshima, 730-0841, Japan
| | - Kei Asano
- Department of Orthopedic Surgery, Shimura Hospital, 3-13 Funairimachi, Naka-ku, Hiroshima, 730-0841, Japan
| | - Shojiro Akahoshi
- Department of Orthopedic Surgery, Obase Hospital, 1598 Aratsu, Kandamachi, Miyako, Fukuoka, 800-0344, Japan
| | - Toru Ishikura
- Department of Orthopedic Surgery, Obase Hospital, 1598 Aratsu, Kandamachi, Miyako, Fukuoka, 800-0344, Japan
| | - Shito Fukuhara
- Department of Orthopedic Surgery, Obase Hospital, 1598 Aratsu, Kandamachi, Miyako, Fukuoka, 800-0344, Japan
| | - Yoshifumi Fuse
- Department of Orthopedic Surgery, Saka Midorii Hospital, 6-28-1 Midorii, Asaminami-ku, Hiroshima, 731-0103, Japan
| | - Toshiyuki Mizuno
- Department of Orthopedic Surgery, Shobara Red Cross Hospital, 2-7-10 Nishihonmachi, Shobara, Hiroshima, 727-0013, Japan
| | - Yuji Katae
- Department of Orthopedic Surgery, Akaike Kyodo Clinic, 521Akaike, Fukuchimachi, Tagawa, Fukuoka, 822-1101, Japan
| | - Hidehiro Matsumoto
- Department of Orthopedic Surgery, Sanzai Hospital, 3378 Shimosanzai, Saito, Miyazaki, 881-0113, Japan
| | - Takayuki Ogawa
- Department of Orthopedic Surgery, Kaisei General Hospital, 3-5-28 Muromachi, Sakaide, Kagawa, 762-0007, Japan
| | - Shigeki Nishida
- Department of Orthopedic Surgery, Shin-Kokura Hospital, 1-3-1 Kanada, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8505, Japan
| | - Satoshi Ikeda
- Department of Orthopedic Surgery, Ken-Ai Memorial Hospital, 1191 Kimori, Onga-cho, Onga, Fukuoka, 811-4313, Japan
| | - Kunitaka Menuki
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, 807-8555, Japan
| | - Jun Saito
- Department of Orthopedic Surgery, Shunankogen Hospital, 29-1 Susumahongo, Shunan, Yamaguchi, 745-0122, Japan
| | - Yuichi Okazaki
- Department of Orthopedic Surgery, Tobata General Hospital, 1-3-33 Fukuryugi, Tobata, Kitakyushu, Fukuoka, 804-0025, Japan
| | - Naoyuki Mizuno
- Department of Orthopedic Surgery, Saiseikai Kure Hospital, 2-1-13 Sanjyo, Kure, Hiroshima, 737-0821, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, 6-13-1 Yasuhigashi, Asaminami-ku, Hiroshima, 731-0153, Japan
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21
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Ajwa N. The role of bisphosphonates in orthodontic tooth movement-A review. J Family Med Prim Care 2019; 8:3783-3788. [PMID: 31879614 PMCID: PMC6924235 DOI: 10.4103/jfmpc.jfmpc_825_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 09/26/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022] Open
Abstract
The present study has reviewed and put insights on the reports and recent literatures confined to the effects of bisphosphonate (BP) medication on orthodontic tooth movement (OTM). Pharmacological anchorage control plays a vital role in orthodontic treatment planning to the required patients. BPs inhibit bone resorption by involving increased activity of mineral adsorption on the bone surfaces where BPs tend to target osteoclasts. The present study reviewed on the latest report and examined cases relating to the impact of BPs in OTM. Clinical implication, chemical formulation, and mode of action of BPs have been discussed. This reviewspecifically focused on various kinds of BPs used in medication for bone adsorption in OTM therapy. Furthermore, it tries to explore the rare adverse and side effects of BPs observed based on the literatures. A systematic literature search was attempted in the Medline database (PubMed) using appropriate keywords, such as orthodontic tooth movement, bisphosphonates, and manual hand look was more overdone. On the basis of reports examined, BP treatments in OTM have posed an increased trend toward the benefit and interfere with osteoclastic resorption. In many cases, they may be advantageous for mooring strategies and encourage long-term planned randomized controlled trials to evaluate conceivable benefits and antagonistic impacts of BP treatments for OTM, before initiating remedial use.
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Affiliation(s)
- Nancy Ajwa
- Department of Preventive Dental Science, Orthodontic Division, Riyadh Elm University, Riyadh, KSA
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22
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Suzuki H, Bando K, Tada H, Kiyama T, Oizumi T, Funayama H, Sugawara S, Takahashi T, Endo Y. Augmentation of Lipopolysaccharide-Induced Production of IL-1α and IL-1β in Mice Given Intravenous Zoledronate (a Nitrogen-Containing Bisphosphonate) and Its Prevention by Clodronate (a Non-nitrogen-containing Bisphosphonate). Biol Pharm Bull 2019; 42:164-172. [PMID: 30713248 DOI: 10.1248/bpb.b18-00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bisphosphonates (BPs) bind strongly to bone and exhibit long-acting anti-bone-resorptive effects. Among BPs, nitrogen-containing BPs (N-BPs) have far stronger anti-bone-resorptive effects than non-N-BPs. However, N-BPs induce acute inflammatory reactions (fever, arthralgia and myalgia, etc.) after their first injection. The mechanisms underlying these side effects remain unclear. Zoledronate (one of the most potent N-BPs) is given intravenously to patients, and the side-effect incidence is reportedly the highest among N-BPs. Our murine experiments have clarified that (a) intraperitoneally injected N-BPs induce various inflammatory reactions, including a production of interleukin-1 (IL-1) (a typical inflammatory cytokine), and these inflammatory reactions are weak in IL-1-deficient mice, (b) subcutaneously injected N-BPs induce inflammation/necrosis at the injection site, (c) lipopolysaccharide (LPS; a cell-wall component of Gram-negative bacteria) and N-BPs mutually augment their inflammatory/necrotic effects, (d) the non-N-BP clodronate can reduce N-BPs' inflammatory/necrotic effects. However, there are few animal studies on the side effects of intravenously injected N-BPs. Here, we found in mice that (i) intravenous zoledronate exhibited weaker inflammatory effects than intraperitoneal zoledronate, (ii) in mice given intravenous zoledronate, LPS-induced production of IL-1α and IL-1β was augmented in various tissues, including bone, resulting in them increasing in serum, and (iii) clodronate (given together with zoledronate) prevented such augmentation and enhanced, slightly but significantly, zoledronate's anti-bone-resorptive effect. These results suggest that infection may be a factor promoting the acute inflammatory side effects of N-BPs via augmented production of IL-1 in various tissues (including bone), and that clodronate may be useful to reduce or prevent such side effects.
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Affiliation(s)
- Hikari Suzuki
- Division of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University
| | - Kanan Bando
- Division of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Tohoku University
| | - Hiroyuki Tada
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Tomomi Kiyama
- Division of Advanced Prosthetic Dentistry, Graduate School of Dentistry, Tohoku University
| | - Takefumi Oizumi
- Division of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University
| | - Hiromi Funayama
- Department of Pediatric Dentistry, Tsurumi University School of Dental Medicine
| | - Shunji Sugawara
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University
| | - Yasuo Endo
- Division of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University
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23
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Zhang J, Zhang T, Xu X, Cai Q, Zhao D. Zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fracture in a single T12 or L1 vertebral body in postmenopausal women. Osteoporos Int 2019; 30:1475-1480. [PMID: 30976888 DOI: 10.1007/s00198-019-04896-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED We performed a 1-year prospective study to see whether zoledronic acid infusion combined with percutaneous kyphoplasty could provide more benefits in the treatment of T12 or L1 osteoporotic vertebral compression fracture (OVCF). INTRODUCTION To investigate and analyze the clinical effects of zoledronic acid (ZOL) in combination with percutaneous kyphoplasty (PKP) in the treatment of OVCF in postmenopausal women. METHODS Included in this study were 101 postmenopausal women patients with T12 or L1 OVCF who received PKP in our hospital between August 2015 and July 2017. They were randomly assigned to a zoledronic acid (ZOL) group (n = 50) or a control group (n = 51). Patients in ZOL group were treated preoperatively with IV infusion of 5 mg ZOL in combination with 0.25μg/d calcitriol and D3 600 mg/d calcium carbonate for a year. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate D3 without ZOL. RESULTS There was no statistically significant difference in age, height, weight, body mass index (BMI), menopause age, and the fractured vertebral body between the two groups. At 6 and 12 months after treatment, bone mineral density (BMD) in ZOL group was higher than that in the control group (p < 0.01); bone markers (NMID, P1NP, and β-CTX) and the VAS score in ZOL group were significantly lower than those in the control group. No new fracture occurred in ZOL group. The incidence of recompression vertebral fracture (RVF) in the control group was 11.7%, while no RVF was detected in any patient in ZOL group. Mild adverse reactions in ZOL group were significantly higher than those in the control group, but all of them were relieved after symptomatic treatment. CONCLUSIONS ZOL IV infusion in combination with PKP is beneficial for the treatment of T12 or L1 OVCF.
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Affiliation(s)
- J Zhang
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - T Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - X Xu
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - Q Cai
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - D Zhao
- Department of Rheumatology, Changhai Hospital, Shanghai, China.
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24
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Abstract
Bisphosphonates are stable structural analogs of pyrophosphate, which suppress the activity of osteoclasts, leading to decreased bone resorption. They are essential medications in the treatment of osteoporosis. Osteonecrosis of the jaw is a serious adverse effect of bisphosphonate therapy. The prevalence of bisphosphonate-related osteonecrosis of the jaw varies from 0% to 28%, and it can be triggered by dental extraction and trauma. Root canal therapy can delay, or even eliminate, the need for tooth extraction, and therefore, may reduce the risk of bisphosphonate-related osteonecrosis of the jaw. We suggest that this might be the best treatment for teeth with pulpal and/or periapical disease.
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Affiliation(s)
- Mothanna K AlRahabi
- College of Dentistry, Taibah University, Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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25
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Takeuchi Y, Hashimoto J, Nishida Y, Yamagiwa C, Tamura T, Atsumi A. Safety and effectiveness of monthly intravenous ibandronate injections in a prospective, postmarketing, and observational study in Japanese patients with osteoporosis. Osteoporos Sarcopenia 2018; 4:22-28. [PMID: 30775537 PMCID: PMC6362972 DOI: 10.1016/j.afos.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This postmarketing, observational study evaluated the safety and effectiveness of monthly intravenous (IV) ibandronate in Japanese patients with osteoporosis. METHODS Eligible patients received monthly IV ibandronate 1 mg for 12 months. Adverse drug reactions (ADRs) were evaluated. Changes in bone mineral density (BMD) and bone turnover markers (BTMs) were assessed using matched t-test analysis. Cumulative fracture rates were analyzed by Kaplan-Meier methodology. RESULTS In total, 1062 patients were enrolled, of whom 1025 (n = 887 women, n = 138 men) were treated. Mean patient age was 77 years. Seventy-five ADRs were reported in 54 patients (5.26%). Four patients (0.39%) experienced serious ADRs, including one case of osteonecrosis of the jaw. Acute-phase reactions occurred in 21 patients (2.04%), and half of them arose after the first ibandronate injection. No new safety concerns were identified. Significant increases in BMD at 12 months relative to baseline were observed at the lumbar spine (4.84%, n = 187; 95% confidence interval [CI], 3.47%-6.21%), femoral neck (2.73%, n = 166; 95% CI, 1.46%-4.01%), and total hip (1.93%, n = 133; 95% CI, 0.80%-3.07%). Significant reductions were observed in all BTMs at 12 months (n = 174 in tartrate-resistant acid phosphatase-5b, n = 101 in procollagen type 1 N-terminal propeptide at baseline). The cumulative incidence of nontraumatic, new vertebral and nonvertebral fractures was 3.16% (95% CI, 2.12%-4.70%). Analyses in women only showed similar results to the overall population. CONCLUSIONS These findings confirm the favorable safety and consistent effectiveness of ibandronate, and indicate that monthly IV ibandronate would be beneficial in daily practice for the treatment of Japanese patients with osteoporosis.
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Affiliation(s)
- Yasuhiro Takeuchi
- Endocrine Center, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Junko Hashimoto
- Project & Lifecycle Management Unit, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yosuke Nishida
- Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Chiemi Yamagiwa
- Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Takashi Tamura
- Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Akihide Atsumi
- Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
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