Lesión hepatocelular inducida por alendronato

Tetrazine-Derived Near-Infrared Dye for Targeted Photoacoustic Imaging of Bone

A near-infrared photoacoustic probe was used to image bone in vivo through active and bioorthogonal pretargeting strategies that utilized coupling between a tetrazine-derived cyanine dye and a trans-cyclooctene-modified bisphosphonate. In vitro hydroxyapatite binding of the probe via active and pretargeting strategies showed comparable increases in percent binding vs a nontargeted control. Intrafemoral injection of the bisphosphonate-dye conjugate showed retention out to 24 h post-injection, with a 14-fold increase in signal over background, while the nontargeted dye exhibited negligible binding to bone and signal washout by 4 h post-injection. Intravenous injection, using both active and pretargeting strategies, demonstrated bone accumulation as earlier as 4 h post-injection, where the signal was found to be 3.6- and 1.5-fold higher, respectively, than the signal from the nontargeted dye. The described bone-targeted dye enabled in vivo photoacoustic imaging, while the synthetic strategy provides a convenient building block for developing new targeted photoacoustic probes.

Safety and efficacy of hydroxyapatite scaffold in the prevention of jaw osteonecrosis in vivo

Two scaffolds of chitosan/sodium alginate/hydroxyapatite (Ch/NaAlg/Hap) 1:1:0.2 and 1:1:0.6 were evaluated in the prevention of bisphosphonate-induced jaw osteonecrosis. Two groups of rats (n = 24, according to the euthanasia time: 15 or 30 days after the last Zoledronic acid (ZA) administration) were subdivided in four subgroups (n = 6): I - Control (saline + teeth extraction); II - ZA 0.6 mg/kg + teeth extraction; III - ZA + teeth extraction + scaffold 1:1:0.2; IV - ZA + teeth extraction + scaffold 1:1:0.6. Jaws were evaluated histologically and blood was evaluated for hematological and biochemical parameters. Histopathology showed significant osteonecrosis in AZ group. The scaffold's implantation, despite the inflammatory process, were able to prevent the osteonecrosis. In the 15-day euthanasia group, an increase in red blood cells and platelets was observed in the subgroup II. Hemoglobin and hematocrit decreased in subgroup IV compared to II. Hepatic transaminases and creatinine concentration increased significantly in subgroup II. Calcium concentration increased in subgroup IV compared to II. In the 30-day euthanasia group, no differences among the groups were observed for any parameter. Scaffolds proved to be efficient and safe to liver and kidney function. Some hematological parameters were altered by the scaffold, but returned to normal concentrations over time. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1799-1808, 2018.

Zoledronic acid-induced hepatotoxicity relieved after subsequent infusions in a Chinese woman with glucocorticoid-induced osteoporosis

BACKGROUND

Zoledronic acid (ZOL) is widely used for treatment of glucocorticoid-induced osteoporosis. The most common adverse effects of ZOL treatment are post-dose symptoms. ZOL-induced hepatotoxicity has very rarely been reported.

CASE REPORT

Here, we described a 50-year-old Chinese woman who had vertebral fractures and severe back pain after glucocorticoid therapy for Behcet disease for 13 years. Three days after ZOL 5 mg infusion in April 2012, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) levels increased by 7.7, 4.9 and 3.0 times, respectively, compared with pre-treatment values. Liver protective agents were administered per os. Her hepatic enzyme levels returned to nearly normal range 9 days post-infusion. In the subsequent ZOL infusion with 1 year interval, serum ALT, AST and GGT levels increased slightly after the second infusion and were sustained to be normal after the third infusion. Her post-dose symptoms alleviated in the meantime.

CONCLUSIONS

Hepatotoxicity due to ZOL therapy is a rare, but possible adverse effect which may be relieved after subsequent infusions.

Severe immune-mediated drug-induced liver injury linked to ibandronate: a case report

Ibandronate is a widely used bisphosphonate with no previously well documented hepatotoxicity. We report the first case of ibandronate-related hepatotoxicity and, to our knowledge, the first case of immune-mediated drug-induced liver injury (DILI) related to bisphosphonates.

Safety of long-term bisphosphonate therapy for the management of osteoporosis

Drugs in the bisphosphonate class are the most commonly prescribed therapeutic agents for the treatment of osteoporosis. Prospective, randomized, placebo-controlled clinical trials have demonstrated efficacy in reducing fracture risk, with favourable safety profiles, in women with postmenopausal osteoporosis. However, long-term use in clinical practice has been associated with reports of undesirable events not previously recognized. These have included gastrointestinal intolerance, osteonecrosis of the jaw, atypical femur fractures, oesophageal cancer, atrial fibrillation and chronic musculoskeletal pain. Physicians must be alert to newly recognized safety concerns, understand the level of evidence supporting them and be able to effectively communicate the balance of expected benefit and potential risk to patients. Usually, post-marketing adverse events are first presented as case reports or observational studies with variable levels of supporting evidence for plausibility, pathophysiology and causality. Widespread coverage in the news media, which can be alarming to patients and their physicians, may not present a balanced view of the proven benefits, the uncertain risks of therapy and the relative magnitude of these events. There may be confusion about the risks associated with bisphosphonate use for the treatment of osteoporosis versus treatment of other conditions, such as cancer, which typically involves a very different patient population and different doses or frequency of drug administration. Often reports of possible adverse events do not provide information on the number of patients exposed to the drug in proportion to the reported adverse event, or do not describe the incidence of the adverse event in a comparator population not exposed to the drug. Gastrointestinal intolerance with oral bisphosphonates, and hypocalcaemia, acute phase reactions and renal toxicity with intravenous bisphosphonates are characterized by biological plausibility and demonstration of causality. Safety concerns with uncertain biological plausibility and unproven causality include osteonecrosis of the jaw, atypical femur fractures, oesophageal cancer and ocular inflammation. Suspected concerns that are unlikely to be causally related include atrial fibrillation and hepatotoxicity. When making the decision to use a bisphosphonate for the treatment of osteoporosis, the balance between benefit and potential risks according to clinical circumstances of each patient should be considered.

Zoledronic acid-induced transient hepatotoxicity in a patient effectively treated for Paget's disease of bone

Bisphosphonate (BP)-induced hepatotoxicity is very rare. There are only a few reports of liver injury after BP treatment, including aledronate and risedronate in postmenopausal osteoporosis patients. We describe hereby the case of a patient with Paget's disease of bone accompanied by nonalcoholic fatty liver disease (NAFLD) who developed transient hepatotoxicity after zoledronic acid (ZOL) treatment. NAFLD had been diagnosed 1 year before presentation, based on liver ultrasonography (US). One day after infusion, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) were increased by 8.1, 6.7, and 6.7 times, respectively, compared with pretreatment values. Serum bilirubin remained normal. US revealed hepatic mild homogenous brightness without focal lesion of the liver or biliary ducts. Subsequent biochemical and serologic investigation did not reveal a specific liver or systematic disease. The patient remained asymptomatic, and ALT, AST, and GGT were normalized 7 days post-treatment. Although the mechanism by which ZOL may cause liver damage is elusive, physicians should be aware of this possible adverse effect and ZOL cautiously administered in NAFLD patients.

Hepatotoxicity induced by alendronate therapy

Here we describe a 47-year-old postmenopausal woman who had been taking alendronate 70 mg/week for osteoporosis. After two months of alendronate therapy, she developed hepatotoxicity, and no other etiological factors for this besides the alendronate were apparent. After the alendronate therapy was discontinued, the patient's hepatic enzyme levels slowly returned to normal. Hepatotoxicity due to alendronate therapy is a rare but possible adverse effect.

Drug-induced liver disease

Although the year 2001 did not see any prescription drugs withdrawn because of drug-induced liver disease, the US Food and Drug Administration requested that dietary supplements containing comfrey be taken off the market because of the danger of hepatic injury. The Food and Drug Administration remains very involved in the process by which drug-induced liver disease can be detected early in drug development and in the determination of how best to prevent hepatotoxicity after drug approval. A workshop on drug-induced liver disease cosponsored by the Food and Drug Administration, the Pharmaceutical Research and Manufacturers Association, and the American Association for the Study of Liver Diseases was held in Washington, DC, in February 2001, and the resulting white paper outlined several areas for research. A number of agents were newly described as causing various forms of liver injury, and several others had drug-induced liver disease confirmed by additional reports. Several investigators dealt with the difficulties inherent in establishing causality of drug-induced liver disease and the potential negative consequences of wrongly attributing hepatotoxicity to a particular agent. In one recent series, more than half the instances of alleged drug-induced liver disease were found to have other causes, often leading to a delay in the actual diagnosis and appropriate management. Case reports in particular were often misleading. Although several drug assessment scales have been developed, none appears to be foolproof.