Intermittent Dosing of Zoledronic acid reduces vertebral and non-vertebral fractures.

<h2>Background&nbsp;</h2><ul><li>Zoledronic acid (ZOL) is an anti-osteoporosis medicine that mostly is given intravenously once a year.</li><li>Some studies indicate that more infrequent dosing may offer equivalent antifracture effectiveness compared to dosing once a year</li><li>Bone turnover markers (BTM) can predict the antifracture efficacy of antiresorptive agents, with procollagen type 1 N-terminal propeptide (P1NP) being the most useful marker.</li><li>Duration of BTM suppression following a ZOL infusion differ between patients, and therefore, individually tailored treatment can be required.</li></ul><h2 id="aim">Aim</h2><ul><li>This study investigated whether intermittent dosing of ZOL based on BTM levels could maintain sufficient antifracture efficacy</li><li><strong>Objectives were to explore:</strong><ul><li>Effects of iv. dosing of ZOL given at S-P1NP &gt; 35 ug/L on increases in BMD.</li><li>Effects of iv. dosing of ZOL given at S-P1NP &gt; 35 g/L on the incidence of vertebral and non-vertebral fractures.</li><li>Rate of reinfusion of ZOL given at S-P1NP &gt; 35 ug/L</li></ul></li></ul><h2 id="methods">Methods</h2><ul><li>Patients (N = 202, mean age 68.2 years) with osteoporosis were treated with ZOL for an average of 4.4 (range 2-8) years.</li><li>S-P1NP and Bone Mineral Density (BMD) were measured at baseline and every 1-2 years.</li><li>All the patients had an intravenous infusion of 5-mg ZOL at baseline.</li><li><strong>Assessment parameters:</strong> Number of subsequent vertebral and nonvertebral fractures in the 2-year time periods.</li></ul><h2 id="results">Results</h2><ul><li>Number of patients assessed was 202, 147, 69, and 29 at years 1-2, 3-4, 5-6, and 7-8, respectively.</li><li>In cases where S-P1NP levels exhibited values above 35 pg/L ,a new ZOL infusion was administered. BMD increased by 6.2% (SD 4.0) over the first 2 years and stabilized in years 2-8 (P&lt;.05). (Table 1).</li><li>Median S-P1NP exhibited an initial reduction from 58.0 to 31.3 g/L at year 2 and then increased to 39.0 ug/L at years 7-8. (Table 1)</li><li>Vertebral fractures exhibited consistent reductions ranging between 32% in years 1-2 to 72% in years 7-8. (Table 1)</li></ul><figure class="image"><img style="aspect-ratio:707/366;" src="https://cdn.megawecare.com/GHBY/Internal-Images/BMD-serum-procollagen-type-1.webp" width="707" height="366"></figure><h2 id="conclusion">Conclusion</h2><ul><li>This study demonstrated that intermittent administration of intravenous ZOL based on bone marker cut-offs resulted in an initial increase in stable BMD subsequent suppression of S-P1NP, and consistent decrease in fractures over an 8-year period.</li><li>Achieving a reduction in bone markers, consistent BMD increases, and sustained fracture reduction, by dosing ZOL intermittently based on bone marker cut-offs.</li><li>Exposure to decrease total doses of bisphosphonate could also potentially reduce the risk of rare side effects such as osteonecrosis of the jaw and atypical femoral fracture.</li></ul>

Orthopedics Update July 2024   01

<ul><li><a href="#background">Background</a></li><li><a href="#aim">Aim</a></li><li><a href="#methods">Methods</a></li><li><a href="#results">Results</a></li><li><a href="#conclusion">Conclusion</a></li></ul>

Intermittent Dosing of Zoledronic acid reduces vertebral and non-vertebral fractures.

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