Zoledronic Acid (Zometa®, Reclast®) | OncoLink

Author: Karen Arnold-Korzeniowski, BSN RN

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Last Reviewed: August 5, 2021

Pronounced: ZOE-le-DRON-ik AS-id

Classification: bisphosphonate

About: Zoledronic Acid (Zometa®, Reclast®)

Zoledronic acid is a type of medication called a bisphosphonate, which is used to slow the destruction of bone caused by cancer cells. Cancer cells from some tumors (most commonly breast, prostate and lung cancers) can spread to the bone, which is called bone metastasis. Multiple myeloma is a type of cancer affecting plasma cells, which are found in the bone marrow, and thus directly involves bone. In both of these situations, the cancer cells cause breakdown or wearing away of normal bone. In turn, affected bones become more fragile; they may be painful and can even break due to the damage from the cancer cells.  

How to Take Zoledronic Acid

Zoledronic acid is administered intravenously (IV, into a vein). Your dose, and how often you receive it, will be determined by your provider. Your healthcare provider may prescribe you calcium and vitamin D supplements to promote bone health.

You will have lab work done to monitor your electrolytes during treatment. Your creatinine level (indicator of your kidney function) will be monitored closely to determine if the medication is affecting your kidneys. If it is, the dose may be altered or the medication stopped completely.

Possible Side Effects of Zoledronic Acid

There are a number of things you can do to manage the side effects of zoledronic acid. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. 

Bone, Joint, and Muscle Pain

Zoledronic acid can cause bone, joint and/or muscle pain that can be severe. This can occur from 1 day to several months after starting the medication. Report these symptoms to your provider, who can advise you on strategies to relieve the pain. Pain in the hip, thigh, and groin can be caused by an atypical femur fracture. Notify your provider immediately of any new pain in this area. 

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Breathing Difficulties

Bronchoconstriction is the constriction of the lung airways caused by muscle tightening. Patients who are sensitive to aspirin may have bronchoconstriction related to zoledronic acid. Notify your provider of any trouble breathing, tightness in the chest or wheezing. 

Less common but important side effects can include:

• Osteonecrosis of the Jaw: Osteonecrosis of the jaw (ONJ) is a rare side effect, however, it is important that you know about it and take steps to protect your dental health. The maxilla (upper jaw bone) and mandible (lower jaw bone) are normally covered by gum tissue. In the case of ONJ, this tissue disappears and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw or a “heavy” feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. ONJ most often occurs soon after a dental procedure, though not always. Stop treatment with zoledronic acid at least 3 weeks prior to any dental procedures.
  • Prior to starting therapy, you should have a complete dental exam, cleaning, and removal of any teeth in poor health.
  • Dentures should be checked for proper fit.
  • Brush your teeth after meals and at bedtime with a soft brush. Floss gently once a day. If your gums bleed, talk with your healthcare team to see if you can continue to floss.
  • Check your teeth and gums in a mirror daily for any sores, swelling, loose teeth, pain or numbness, or other changes and report these to your dentist or oncology team immediately.
• Acute Reaction: The infusion can cause a reaction that occurs within 3 days of the infusion and may cause chills, fever and muscle aches. Prior to taking any medications, check with your healthcare provider as these can also be signs of infection. If you are able to take anti-inflammatory medications, such as ibuprofen (Motrin) and naproxen (Aleve), they may be helpful in treating these side effects. Reactions are most common during or shortly after the first infusion, but not after subsequent doses.
• Kidney problems: This medication can cause kidney problems, including an increased creatinine level, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.
• Hypocalcemia: This medication can lower your calcium levels. Your healthcare team will monitor your calcium levels with blood tests. If you experience muscle cramps or confusion, contact your healthcare team.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.

Zoledronate – StatPearls – NCBI Bookshelf

Continuing Education Activity

Zoledronate, also known as zoledronic acid, is an example of a class of drugs known as bisphosphonates. It is a bisphosphonate that is administered intravenously. This medication is used to treat many forms of metabolic bone disease. Zoledronate is broadly classified as an antiresorptive medication. Zoledronate is a commonly prescribed agent that is approved and indicated for both benign and malignant bone disorders. This activity outlines the indications, actions, and contraindications for zoledronate. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, monitoring) pertinent for members of a healthcare team to utilize in the treatment of patients on zoledronate.

Objectives:

• Outline the indications for the use of zoledronate.

• Review the mechanism of action of zoledronate.

• Describe adverse reactions associated with zoledronate.

• Summarize the contraindications and monitoring needed for zoledronate.

Access free multiple choice questions on this topic.

Indications

Zoledronate, also known as zoledronic acid, is an intravenous (IV) medication that belongs to a class of drugs known as bisphosphonates. It is an antiresorptive therapy used to treat various bone conditions, including both malignant and benign diseases.[1]

Food and drug administration (FDA) approved indications for this agent include the prevention and treatment of osteoporosis in postmenopausal females, osteoporosis in males, glucocorticoid-induced osteoporosis, Paget disease of bone, hypercalcemia of malignancy, multiple myeloma, and solid tumor bone metastases.[2][3][4][5][6][7][8]

Non-FDA-approved indications include adjuvant therapy in breast cancer, bone loss in postmenopausal patients related to aromatase inhibitor therapy, and bone loss related to androgen deprivation therapy. [9][10]

As zoledronate is administered intravenously, it can be used in patients with an intolerance or contraindication to oral bisphosphonates. It is the treatment of choice for Paget disease of bone and hypercalcemia of malignancy. Using zoledronate as initial therapy in preventing postmenopausal osteoporosis is also appropriate in patients with very high fracture risk.[2][11]

The American Association of Clinical Endocrinologists defined very high fracture risk in the 2020 postmenopausal osteoporosis guideline. A patient is said to be at a very high fracture risk if at least one of the following is present, including

1. Postmenopausal with a history of multiple fractures

2. The presence of a fracture within the preceding 12 months

3. Fracture(s) despite being on appropriate osteoporosis treatment

4. Fracture while on a drug known to cause skeletal harm

5. T-score less than -3.0

6. High fall risk, history of a fall resulting in an injury, or a very high risk of a fracture using a validated fracture risk algorithm[2]

Mechanism of Action

An integral step in new bone formation is the avid binding of inorganic pyrophosphate (PPi) to hydroxyapatite crystals found in bone. Nitrogen-containing bisphosphonates such as zoledronate are PPi analogs with a higher binding affinity. These bisphosphonates, therefore, preferentially bind to bone, especially at sites that are being actively remodeled. The bone-bound bisphosphonates are released during the process of bone breakdown by osteoclasts.

Once released, the bisphosphonate is then absorbed by osteoclasts. Within the osteoclasts, the bisphosphonate binds to and blocks the activity of farnesyl diphosphate synthase (FPPS). FPPS is an essential intracellular enzyme in the 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase pathway responsible for producing isoprenoid lipids, cholesterol, and other sterols. Inhibition of this pathway prevents the posttranslational modification of small proteins, including guanosine triphosphate binding proteins, which are needed for the activity and survival of osteoclasts.

Therefore, the administration of zoledronate increases osteoclast apoptosis, thus reducing bone resorption and loss. Osteoblastic activity and bone formation are not impacted by the use of zoledronate. Hence the use of this agent shifts bone metabolic activity in favor of bone formation, reducing bone loss. This ultimately leads to an increase in bone mass and bone density as bone formation exceeds resorption.[12]

Administration

Zoledronate is administered in the following manner:

Dose adjustments may be necessary for patients with renal dysfunction and are as follows:

Adverse Effects

Adverse effects associated with zoledronate include hypocalcemia, secondary hyperparathyroidism, musculoskeletal pain, acute phase response, renal injury, atypical femur fractures, osteonecrosis of the jaw, atrial fibrillation, and ocular inflammation.[17][18]

All bisphosphonates can cause hypocalcemia and secondary hyperparathyroidism; IV formulations such as zoledronate are more prone to cause these adverse effects. Normal serum calcium is largely maintained by a balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption. The mechanism behind hypocalcemia and secondary hyperparathyroidism from zoledronate use relates to its actions on the osteoclasts.

Zoledronate halts bone resorption and calcium release by osteoclasts, resulting in hypocalcemia. To conserve calcium, parathyroid hormone (PTH) levels increase and antagonize the actions of zoledronate by acting at the level of the kidneys. The increase in PTH and a decrease in both serum phosphorus and calcium are dose-dependent. In the kidneys, PTH stimulates the production of 1,25-dihydroxy vitamin D, and tubular reabsorption of calcium is increased. Over time bisphosphonate-induced hypocalcemia will typically abate.

However, symptomatic hypocalcemia can occur and would be seen within days of zoledronate administration. Risk factors for symptomatic hypocalcemia include renal failure, vitamin D deficiency, and preexisting hypoparathyroidism. To reduce this risk, supplementation with calcium and vitamin D with the use of zoledronate is recommended. Supplementation should begin at least two weeks before zoledronate administration.[17]

Musculoskeletal pain, including myalgias and arthralgia, has been reported after zoledronate therapy. This adverse effect has been said to occur at varying time points following treatment, ranging from days to years. The mechanism behind this effect is not understood.[17][18]

An acute phase response (APR) with arthralgias, myalgias, pyrexia, chills, and fatigue has been described – this is described as a post-infusion influenza-like illness. This adverse effect is most common following the first infusion, with the frequency and incidence of APR decreasing with subsequent infusions. Symptoms begin approximately 24 to 72 hours following the infusion and resolve within 72 hours.

APR is often self-limiting, though symptomatic treatment with non-steroidal anti-inflammatory drugs or acetaminophen is recommended. Recent data suggest that the coadministration of zoledronate with acetaminophen may reduce the risk of APR in half. The risk of APR may be influenced by the underlying indication for which treatment was initiated.[17][18]

APR is thought to be mediated by high levels of pro-inflammatory cytokines, including interleukin-6 and tumor necrosis factor-alpha. A study looking at patients receiving treatment for aromatase inhibitor-associated osteoporosis noted that APR was around 70%. A large study looking at APR after using zoledronate in women with post-menopausal osteoporosis revealed the incidence to be approximately 40%.[19][20]

The most common form of renal injury following zoledronate administration is acute tubular necrosis (ATN). Risk factors for the development of ATN have been described and include rapid infusions, shorter time intervals between infusions, and higher doses.[18]

Observational studies have demonstrated a risk between long-term zoledronate use and subtrochanteric or atypical femur fractures. These atypical fractures are located between the diaphysis and subtrochanteric region of the femur. These fractures occur with minimal to no trauma and can be bilateral. Symptoms include aching or dull pain in the thigh or groin. Certain comorbid conditions and medications have been associated with a further increase in the risk, including vitamin D deficiency, rheumatoid arthritis, and corticosteroid use. This risk can be decreased with the use of zoledronate holidays.[21][22]

Zoledronate-induced osteonecrosis of the jaw (ONJ) has been extensively described. This relationship seems to be influenced by both the dose and indication for which the medication is prescribed. Treatment of bone metastasis and multiple myeloma with zoledronate 4 mg IV every 3 to 4 weeks carries a higher risk when compared to the treatment of osteoporosis. Other factors, including head/neck radiation, dental disease, and dental procedures with bone manipulation, are also known to increase the risk of the development of ONJ.[17][18]

Atrial fibrillation has also been reported following zoledronate administration. The data regarding this complication is not as robust as other complications, but studies have shown that zoledronate may modestly increase the risk for atrial fibrillation.[23]

Ocular manifestations have been linked to zoledronate therapy. This includes conjunctivitis, scleritis, and uveitis. Overall these reactions appear to be uncommon but warrant prompt evaluation. Thus, patients receiving zoledronate and experiencing changes in vision, eye pain, or eye redness should be evaluated by an ophthalmologist.[17][18]

Contraindications

The contraindications to using zoledronate depend on the nature and type of disease being treated.

Hypocalcemia, acute kidney injury, or creatinine clearance (CrCl) less than or equal to 35 mL/minute are contraindications for use in benign bone disease.[24] In the treatment of hypercalcemia of malignancy, the use of zoledronate should be avoided in patients with serum creatinine greater than 4.5 mg/dL.[25] 

Minimal data exist regarding treating solid tumor bone metastasis patients with a CrCl of less than 30 mL/min. Therefore caution is necessary for this patient group.[26]

A history of allergic reaction to zoledronate is also a contraindication. This contraindication applies to all indications of zoledronate use.

Zoledronate is pregnancy category D and should be avoided during pregnancy, and caution is necessary for women of childbearing age.

Monitoring

The following labs should be checked before each infusion: renal function and clearance, vitamin d, calcium, magnesium, and phosphorus. Electrolyte imbalances and vitamin D deficiency should be corrected before treatment is initiated.[2]

In patients receiving treatment for osteoporosis, periodic monitoring of bone mineral density should be completed to check for treatment response and effectiveness.[2]

In patients receiving treatment for Paget disease of bone, alkaline phosphatase requires periodic monitoring.[5]

In patients receiving treatment for multiple myeloma, periodic monitoring for albuminuria is required. [7]

Toxicity

In the event of toxicity or overdose, there are no reversal agents approved by the FDA for this drug.

Enhancing Healthcare Team Outcomes

Zoledronate is a versatile medication that helps prevent morbidity and mortality in various conditions. It is used in different medical and surgical specialties. As it is an infused therapy, patients often receive this treatment in a healthcare facility. Interprofessional collaboration is vital to providing safe and effective care with this medication.

Counseling patients regarding potential side effects of zoledronate begins with the physician. Pharmacists play an integral role in checking for drug interactions. Nurses infuse this medication and monitor for adverse reactions. This approach requires collaboration from all healthcare team members and can help ensure our patients are given optimal treatment. 

The safety of patients receiving treatment with zoledronate relies on the prescriber’s knowledge of the contraindications, monitoring, and dose adjustments required when using this medication. For this medication, each indication has different parameters for each of these categories. Careful attention to these details is needed for each patient care team member. 

Healthcare costs and the appropriate utilization of healthcare resources are of utmost importance. When making decisions regarding patient care, one must ensure that when selecting a treatment option, all aspects of the patient are considered. Many treatment options for osteoporosis are available, and when zoledronate is selected as therapy, patients receive this medication in a healthcare facility intravenously.

This medication requires more invasive procedures for administration compared to its oral counterparts. Also, as it is administered under direct supervision in a healthcare facility, the total healthcare cost is higher than other options. These factors should not deter prescribers from utilizing this treatment option, but appropriate patient selection is required for this drug to have the most benefit. [Level 5] 

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References

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Reid IR, Green JR, Lyles KW, Reid DM, Trechsel U, Hosking DJ, Black DM, Cummings SR, Russell RGG, Eriksen EF. Zoledronate. Bone. 2020 Aug;137:115390. [PubMed: 32353565]

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Anderson K, Ismaila N, Flynn PJ, Halabi S, Jagannath S, Ogaily MS, Omel J, Raje N, Roodman GD, Yee GC, Kyle RA. Role of Bone-Modifying Agents in Multiple Myeloma: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018 Mar 10;36(8):812-818. [PubMed: 29341831]

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Pineda-Moncusí M, Garcia-Giralt N, Diez-Perez A, Servitja S, Tusquets I, Prieto-Alhambra D, Nogués X. Increased Fracture Risk in Women Treated With Aromatase Inhibitors Versus Tamoxifen: Beneficial Effect of Bisphosphonates. J Bone Miner Res. 2020 Feb;35(2):291-297. [PubMed: 31596961]

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Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2007 Jan;177(1):17-24. [PubMed: 17161994]

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Ganesan K, Goyal A, Roane D. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 5, 2022. Bisphosphonate. [PubMed: 29262103]

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Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008 Sep;83(9):1032-45. [PMC free article: PMC2667901] [PubMed: 18775204]

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Van Poznak C, Somerfield MR, Barlow WE, Biermann JS, Bosserman LD, Clemons MJ, Dhesy-Thind SK, Dillmon MS, Eisen A, Frank ES, Jagsi R, Jimenez R, Theriault RL, Vandenberg TA, Yee GC, Moy B. Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology-Cancer Care Ontario Focused Guideline Update. J Clin Oncol. 2017 Dec 10;35(35):3978-3986. [PubMed: 29035643]

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Saylor PJ, Rumble RB, Tagawa S, Eastham JA, Finelli A, Reddy PS, Kungel TM, Nissenberg MG, Michalski JM. Bone Health and Bone-Targeted Therapies for Prostate Cancer: ASCO Endorsement of a Cancer Care Ontario Guideline. J Clin Oncol. 2020 May 20;38(15):1736-1743. [PubMed: 31990618]

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Shapiro CL, Van Poznak C, Lacchetti C, Kirshner J, Eastell R, Gagel R, Smith S, Edwards BJ, Frank E, Lyman GH, Smith MR, Mhaskar R, Henderson T, Neuner J. Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline. J Clin Oncol. 2019 Nov 01;37(31):2916-2946. [PubMed: 31532726]

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Eisen A, Somerfield MR, Accordino MK, Blanchette PS, Clemons MJ, Dhesy-Thind S, Dillmon MS, D’Oronzo S, Fletcher GG, Frank ES, Hallmeyer S, Makhoul I, Moy B, Thawer A, Wu JY, Van Poznak CH. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: ASCO-OH (CCO) Guideline Update. J Clin Oncol. 2022 Mar 01;40(7):787-800. [PubMed: 35041467]

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Pazianas M, Abrahamsen B. Safety of bisphosphonates. Bone. 2011 Jul;49(1):103-10. [PubMed: 21236370]

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Santini D, Vincenzi B, Caraglia M, Tonini G. A hitherto unreported high incidence of zoledronic acid-induced acute phase reaction in patients with cancer treatment-induced bone loss. Ann Oncol. 2007 Jan;18(1):201-202. [PubMed: 17021272]

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Reid IR, Gamble GD, Mesenbrink P, Lakatos P, Black DM. Characterization of and risk factors for the acute-phase response after zoledronic acid. J Clin Endocrinol Metab. 2010 Sep;95(9):4380-7. [PubMed: 20554708]

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Rudran B, Super J, Jandoo R, Babu V, Nathan S, Ibrahim E, Wiik AV. Current concepts in the management of bisphosphonate associated atypical femoral fractures. World J Orthop. 2021 Sep 18;12(9):660-671. [PMC free article: PMC8472443] [PubMed: 34631450]

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Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Howe TS, van der Meulen MC, Weinstein RS, Whyte MP. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014 Jan;29(1):1-23. [PubMed: 23712442]

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Kim DH, Rogers JR, Fulchino LA, Kim CA, Solomon DH, Kim SC. Bisphosphonates and risk of cardiovascular events: a meta-analysis. PLoS One. 2015;10(4):e0122646. [PMC free article: PMC4401508] [PubMed: 25884398]

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Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S., HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007 Nov 01;357(18):1799-809. [PMC free article: PMC2324066] [PubMed: 17878149]

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Kawada K, Minami H, Okabe K, Watanabe T, Inoue K, Sawamura M, Yagi Y, Sasaki T, Takashima S. A multicenter and open label clinical trial of zoledronic acid 4 mg in patients with hypercalcemia of malignancy. Jpn J Clin Oncol. 2005 Jan;35(1):28-33. [PubMed: 15681601]

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Khalafallah AA, Slancar M, Cosolo W, Abdi E, Chern B, Woodfield RJ, Copeman MC. Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study. Eur J Cancer Care (Engl). 2018 Mar;27(2):e12638. [PMC free article: PMC5901400] [PubMed: 28134499]

Disclosure: Emma Greear declares no relevant financial relationships with ineligible companies.

Disclosure: Adegbenga Bankole declares no relevant financial relationships with ineligible companies.

• Treatment of osteoporosis in Israel, prices 2023

Treatment of osteoporosis in Israel begins with a 100% accurate diagnosis of the disease by the leading Israeli orthopedist – Ilya Pekarsky. After examining the pathologies, the Assuta orthopedist will draw up a treatment protocol.

If osteoporosis is suspected, the patient should use various methods to treat the disease and strengthen the bones to avoid fractures. Consult with an Assuta orthopedist and find out which treatment method is best for you. The clinic doctor will recommend trying several different methods at once, including drug therapy and changes in diet, physical activity level, and some other lifestyle features.

In this article

• Surveys
• Doctors
• Methods of treatment
• Reviews
• Cost
• Make an appointment
• FAQ

Osteoporosis examination

HOW THE DIAGNOSIS IS GOING ON IN ASSUTA

If osteoporosis is suspected, Assuta will measure your height, as patients with osteoporosis often become shorter. This is because osteoporosis primarily affects the bones of the spine.

Assuta’s doctors will recommend a test to measure bone density. Patients with signs of osteoporosis are shown dual energy x-ray absorptiometry (DEXA). This is the most popular bone density measurement tool. It allows diagnosing bone loss and early osteoporosis.

Quantitative computed tomography (CT) is given as an alternative to some patients. This is an equally effective way to check bone density, but it involves more intense radiation to the body than other methods.

Early signs of osteoporosis can also be detected by foot ultrasound. In addition to these diagnostic procedures, the Assuta clinic doctor will prescribe blood or urine tests for the patient. Based on the results of such tests, it is possible to determine the nature of the disease that served as the root cause of bone loss (sometimes the bones are weakened as a result of a disorder other than osteoporosis). Although osteoporosis in Russia is sometimes randomly diagnosed from an x-ray taken after a fracture or illness, x-rays are not considered an effective way to diagnose osteoporosis early.

Day 1 – Initial inspection

11:00 am
Meeting the patient at the airport, meeting with the personal coordinator of the Assuta clinic, assistance in organizing accommodation for the period of the examination

14:00
Consultation with a diagnostician, initial examination of the patient and taking an anamnesis in Hebrew, issuing referrals for examinations

16:00
Acceptance for revision of materials of examinations passed by the patient at the place of residence (if any)

Day 2 – Diagnosis

09:00
Detailed clinical and biochemical analysis of blood, urine

10:30
Dual energy x-ray absorptiometry (DEXA)

13:00
Computed tomography (CT)

15:30
Foot ultrasound

Day 3 – Treatment Plan

11:00 am
Consultation of the leading orthopedist of the Assuta clinic, examination of the patient and study by the doctor of the results of examinations

14:00
Drawing up an individual treatment protocol, issuing prescriptions for medications

16:00
Translation of medical records into Russian

The price of the osteoporosis diagnostic program in Assuta is $2125 .

Find out the exact cost of treatment in Assuta

Who diagnoses and treats osteoporosis

Osteoporosis treatments in Israel

Prescribed drugs for osteoporosis

All osteoporosis drugs have one goal – to keep bones strong for as long as possible. However, all these drugs act differently and are prescribed by Assuta doctors individually.

1. Bisphosphonates , including alendronate (Binosto, Fosamax), ibandronic acid (Bonviva), and risedronic acid (Actonel, Atelvia), treat osteoporosis by preventing bone breakdown. Bonviva is taken once a month, the rest – once a week. Improper intake of bisphosphonates can lead to ulceration of the esophagus, so it is necessary to follow the instructions for use of the drug with accuracy.
2. Zoledronic acid (Reclast, Zometa) is a once-a-year medication. Patients are given a zoledronic acid drip for 15 minutes. This bisphosphonate strengthens bones and reduces the chance of hip, vertebral, wrist, arm, leg, and rib fractures. Common side effects of the drug include bone pain, nausea, and vomiting. Patients with impaired renal function are advised to discontinue the drug or use it with caution.
3. Raloxifene (Evista) is an osteoporosis medicine that acts like the hormone estrogen and helps maintain bone mass. Scientists, however, have proven that raloxifene is devoid of some of the disadvantages of estrogen: it does not increase the risk of developing breast cancer and uterine cancer. Side effects of the drug include hot flashes and an increased chance of blood clots.
4. Abaloparatide (Tymlos) and teriparatide (Forsteo) are indicated for the treatment of osteoporosis in postmenopausal women and men with severe fractures. These are synthetic forms of parathyroid hormone produced by the human body. Abaloparatide and teriparatide were the first drugs to stimulate new bone growth and increase bone mineral density. The course of daily injections lasts up to two years. Side effects of therapy include nausea, leg cramps, and dizziness.
5. Romosozumab (Evenity) is a monoclonal antibody indicated for menopausal women at high risk of fracture. It blocks the action of a protein called sclerostin and promotes new bone formation. Injections of the drug are carried out once a month. In this case, one patient is prescribed no more than 12 doses.
6. Denosumab (Prolia, Xgeva) treats osteoporosis by preventing the body from breaking down bone tissue. This medicine is indicated for women at high risk, provided that they have already tried other drugs for osteoporosis and have not achieved the desired results. Side effects of therapy include pain in the back, arms, and legs.

Osteoporosis and Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) – estrogen or a combination of estrogen and progestin is a proven effective way to prevent and treat osteoporosis in women.

A study conducted by Assuta Women’s Health Initiative experts showed that estrogen reduces the risk of fractures in women. However, this hormone increases the likelihood of developing other disorders.

The combination of conjugated estrogens and medroxyprogesterone acetate (Prempro), a form of hormone replacement therapy, increases the risk of women developing breast cancer, heart disease, and stroke. On the other hand, the drug Premarin as a monotherapy does not affect the likelihood of breast cancer.

So, while HRT helps preserve bone mass and prevent fractures in postmenopausal women, Assuta’s orthopedist will recommend other drugs first.

If you are interested in hormone replacement therapy, discuss the features, benefits, and risks of taking these drugs with your healthcare professional.

Osteoporosis Nutrition Program

Diet is an important part of osteoporosis treatment in Israel . The body needs to get enough calcium to form and maintain strong, healthy bones. Add as many calcium-rich foods to your diet as possible. These include skim milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and green leafy vegetables. One glass of skimmed milk contains the same amount of calcium as whole milk: 300 mg.

Women under 50 need 1000 mg of calcium every day. The daily intake of calcium for women over 50 is 1200 mg. For men, Assuta nutritionists recommend a daily intake of 1,000 mg of calcium from the age of 25 to 70 and 1,200 mg of calcium from the age of 71.

The body needs vitamin D to absorb calcium and supply it to bones. Adults aged 19 to 70 need 600 IU of this vitamin per day, adults over 70 need 800 IU per day.

Fatty fish, including salmon and tuna, are good sources of vitamin D. However, in general, foods are not very rich in this substance, so some people have to take vitamin supplements to make up for the deficiency.

Since supplemental calcium interferes with the absorption of certain drugs, consult your physician before taking any dietary supplement. Your healthcare provider may recommend taking calcium at a different time of day than your regular medications.

Healthy bones through post-treatment nutrition

There are other recommendations for healthy bones besides fortifying your diet with natural sources of calcium:

• Add skimmed milk powder to your daily meals and drinks, including soups, stews, and casseroles. One glass of powdered milk provides you with approximately one-third of your daily calcium intake.
• Avoid foods rich in phosphorus, a mineral that promotes bone loss. Potential hazards include soft drinks, red meat, and foods with added phosphates. Abuse of alcohol and caffeine also interferes with the normal absorption of calcium. People with osteoporosis should practice moderation in these matters.
• Some people argue that post-menopausal women need to consume as much plant-derived estrogen as possible. Sources of this estrogen are tofu, soy milk, and other soy products. The point of this recommendation is to avoid a sudden drop in estrogen levels. However, scientists still question whether plant sources of estrogen actually prevent or slow down osteoporosis.

Physiotherapy for patients with osteoporosis

Exercise is a great way to keep your bones strong.

This requires two types of physical activity:

• Bodyweight exercises, thanks to which the bone tissue remains in good shape. This category includes running, walking, tennis, climbing stairs and aerobics.
• Muscle strengthening exercises, such as strength training.

To get the most out of your workout, you need to spend at least 30-45 minutes three times a week doing the exercises. However, even short physical activity is good for your body. Swimming and cycling improve heart health, but do not help prevent osteoporosis. The fact is that a person’s own weight during such exercises does not provide sufficient load, and without sufficient load, the bones do not tighten and do not become stronger.

How to get treatment in Israel?

You can ask any questions about treatment at the Assuta clinic using the application on the website or by phone. +7495-7899230 (your call will be forwarded free of charge to the international department of the clinic in Israel). Our consultant doctor will call you back within 1-2 hours. The consultation is completely free. Privacy is guaranteed.

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FAQ

Yes, osteoporosis can be treated. Treatment options at Assuta include medications, lifestyle changes (such as exercise and a healthy diet), and supplements.

You can help prevent osteoporosis by getting enough calcium and vitamin D, doing weight-bearing exercise, not smoking, and avoiding excessive alcohol consumption.

A diet high in calcium and vitamin D may help prevent osteoporosis. Good food sources of calcium include dairy products, leafy greens, and nuts. Vitamin D can be obtained from exposure to sunlight or from foods such as oily fish or fortified foods.

What does Prolia do for your bones? – Celebrity.fm

This medication works by slowing down bone loss to help maintain strong bones and reduce the risk of bone fractures (fractures) . Denosumab belongs to a class of drugs called monoclonal antibodies. It prevents certain body cells (osteoclasts) from breaking down bones.

How long has Prolia been around? But the FDA approved Prolia (denosumab) Amgen in 2010 to prevent fractures in women with osteoporosis two months earlier than expected.

What are the long-term effects of taking Prolia? Rare, long-term side effects of Prolia include: fractures of the spine or femur (femur) . This is serious. Fractures may require surgery, healing may take several months, or both. Before starting treatment with Prolia, talk to your doctor about how long the side effects of Prolia may last.

After all, is Prolia a protein? Denosumab is designed to target RANKL (RANK ligand), a protein that acts as a primary signal to promote bone removal/resorption. In many bone loss conditions, RANKL suppresses the body’s natural defenses against bone breakdown.

Contents

Is Prolia worth the risk?

Is there any danger in using this drug? Studies have shown that Prolia is generally safe and effective for treating osteoporosis and some types of bone loss. . For example, in studies, people taking Prolia up to age 8 had no significant side effects compared to people taking a placebo.

Does Prolia regenerate bone? During this time, postmenopausal women who took Prolia had fewer fractures and increased bone density. Prolia targets a chemical signal called the RANK ligand, which is an integral part of the body’s natural bone breakdown process. Normally, the body is constantly destroying and rebuilding bones. .

What is the safest drug for osteoporosis?

What is the alternative to taking Prolia? alendronate (Fosamax) risedronate (Actonel) ibandronate (Boniva) zoledronic acid (Reclast, Zometa)

Can I have a tooth extracted while taking Prolia?

Prolia has the side effect of in patients undergoing dental extractions. Trauma during extraction of the bone surrounding the tooth can lead to a condition in which the bone dies, and after extraction, fragments of the dead bone are lost from the extraction site.

Can you ever stop Prolia? Scientists and doctors recommend that you do not stop taking Prolia without making a plan for further bone care.

What is the latest treatment for osteoporosis?

Romosozumab (even) .

This is the newest bone building drug for osteoporosis. It is given as an injection every month at your doctor’s office and is limited to one year of treatment.

What is the best and safest treatment for osteoporosis 2021? Essence

Fosamax, Prolia and Boniva are effective treatments for osteoporosis because each can help reduce the risk of fractures. Each also has its own risk of side effects.

Why was Fosamax taken off the market?

Researchers say the fractures occurred because alendronate prevents the body from breaking down bones . This creates thick but brittle bones. In October 2010, the Food and Drug Administration (FDA) ordered Merck to change the drug label to reflect the association between bone fractures. The use of fosamax can also make it harder for fractures to heal.

What is the newest drug for osteoporosis?

Romosozumab (even) .

This is the newest bone building drug for osteoporosis. It is given as an injection every month at your doctor’s office and is limited to one year of treatment.

Can osteoporosis be cured without drugs? Can osteoporosis be cured without medication? Your doctor diagnoses osteoporosis based on the loss of bone density. You may have varying degrees of the disease, and early detection can help you prevent the condition from worsening. You cannot reverse bone loss on your own .

Can I have a root canal during my Prolia treatment? Neither bisphosphonates nor denosumab penetrate the teeth on their own. Therefore, treatments such as prophylaxis, restorations, crowns, bridges, non-surgical root canal treatment, and non-surgical periodontal treatment that do not place undue pressure on the alveolar ridges are considered safe .

What jaw problems does Prolia cause?

Prolia may cause bone loss (osteonecrosis) in the jaw. Symptoms include jaw pain or numbness, red or swollen gums, loose teeth, gum infection, or slow healing after dental procedures. Osteonecrosis of the jaw may be more likely if you have cancer or have received chemotherapy, radiation, or steroids.

Does Prolia cause jaw problems? Prolia may cause dental side effects, including jaw necrosis (jaw bone death). Dental work, such as surgery or tooth extraction, may increase the risk of this side effect. Before starting treatment with Prolia, be sure to tell your doctor about any planned dental work.

Can you be treated by a dentist in Prolia?

Elderly women treated with denosumab (Prolia, Amgen) for 10 years for osteoporosis had a low risk of developing osteonecrosis of the jaw (ONJ), although the risk was higher, although still quite small, if they had major dental intervention noted researchers. report.

Is Prolia tiring? The most common side effects of Prolia are: fatigue (45%), body weakness and lack of energy (45%), back pain (35%), low phosphate levels (32%), nausea (31%) and diarrhea (20%). %).

Do I need to inject Prolia exactly every 6 months?

Prolia is an injection that can be self-administered once every six months for the treatment of osteoporosis. This was associated with an increased risk of fractures after discontinuation.

Does walking help with osteoporosis? You can prevent bone loss with regular exercise such as walking. If you have osteoporosis or fragile bones, regular brisk walking can help keep your bones strong and reduce your risk of future fractures .

What is the fastest way to increase bone density?

10 Natural Ways to Build Healthy Bones

1. Eat lots of vegetables. …
2. Do strength and support exercises. …
3. Eat enough protein. …
4. Eat foods high in calcium throughout the day.