From the Guidelines
Reclast (zoledronic acid) is a highly effective treatment for osteoporosis, reducing the risk of vertebral fractures by about 70%, hip fractures by 40%, and other non-vertebral fractures by 20-25%, as supported by high-quality evidence from the American College of Physicians guideline update 1. The medication works by inhibiting bone resorption, effectively slowing down the process of bone loss while allowing bone formation to continue, resulting in increased bone density and strength. Some key points to consider when prescribing Reclast include:
- Administering the medication as a once-yearly 5 mg intravenous infusion over 15-30 minutes, offering a convenient alternative to daily or weekly oral bisphosphonates.
- Patients should take calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplements while on Reclast.
- Common side effects include flu-like symptoms for 24-72 hours after infusion, which can be managed with acetaminophen.
- Before starting treatment, patients should have dental work completed when possible, maintain good kidney function (creatinine clearance above 35 ml/min), and have normal calcium levels. The American College of Physicians recommends offering pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis, based on high-quality evidence 1. Additionally, the guideline suggests that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis, although the evidence is weaker in this population 1. It is essential to discuss the importance of adherence with patients, as factors such as side effects and inconvenience of taking medications can impact adherence 1. Overall, Reclast is a valuable treatment option for patients with osteoporosis, and its efficacy and safety profile make it a recommended choice for reducing the risk of fractures, as supported by the American College of Physicians guideline update 1.
From the Research
Efficacy of Reclast (Zoledronic Acid) in Treating Osteoporosis
- Reclast (zoledronic acid) is an effective treatment option for patients with osteoporosis, as it improves bone mineral density (BMD) and reduces fracture risk 2, 3, 4.
- Zoledronic acid once yearly for up to 3 years has been shown to improve BMD at several skeletal sites, reduce fracture risk and bone turnover, and preserve bone structure and mass relative to placebo in clinical studies in patients with primary or secondary osteoporosis 2.
- The treatment has also been found to be effective in preventing bone loss in patients with low bone mass, with annual or bi-annual administration being effective 2, 5.
- Studies have demonstrated that zoledronic acid is generally well tolerated, with the most common adverse events being transient, mild-to-moderate post-infusion symptoms, which decrease with subsequent infusions 2, 3, 4, 5.
Comparison with Other Treatments
- A study comparing intravenous zoledronic acid with oral alendronate in patients with a low trauma fracture found that both treatments produced a significant increase in BMD and were well tolerated, with no serious adverse reactions in either group 5.
- However, the study also found that there were significantly more new fractures in the zoledronic acid group than the alendronate group, although the zoledronic acid group was significantly older and had a higher proportion of males at baseline 5.
Long-Term Effects
- Zoledronic acid has been shown to provide sustained anti-fracture efficacy at all relevant skeletal sites, with additional benefits seen when treatment is continued for up to 6 years 2, 4.
- However, there is minimal advantage of treatment beyond 6 years, and treatment discontinuation should be considered after approximately 5 years' therapy in patients with low fracture risk 2.
- A study in Chinese women with postmenopausal osteoporosis found that zoledronic acid increased BMD and improved health-related quality of life over two years of treatment, with significant improvements in lumbar spine and hip BMD, and reduced fall index 6.