7/30/2019 KM Zoledronate guidance for osteoporosis.pdf
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Kent and Medway
Kent and Medway Osteoporosis Network
Guidance on use of Zoledronic Acid 5mg Infusion (Aclasta) for
thetreatment of Osteoporosis
The Kent and Medway Area Prescribing Committee (APC) ratified
this local guidance on 30
April 2008. The guidance will be reviewed 2 years from this
date, or earlier if newly published
evidence or national guidance makes this appropriate.
Zoledronic Ac id- This is a new bisphosphonate drug licensed for
the treatment of
osteoporosis in post-menopausal women at increased risk of
fracture. It is given by a
12 monthly intravenous injection (5mg) over not less than15
minutes. It has been
shown to reduce vertebral fractures, non vertebral fractures and
hip fractures incomparison to placebo. Adequate calcium and vitamin
D intake are recommended in
association with Zoledronic Acid administration which still
needs to be taken daily
throughout the year.
Place in treatment
Zoledronic acid is recommended for secondary prevention of
osteoporosis. Initiation
and first dose of treatment should be by secondary care only
until further experience
is gained. (Very occasional use as primary prevention may be
initiated in secondary
care only.)
1st
line treatmentin the following only:-
1. Zoledronic acid should be given first line in patients post
fracture that have
cognitive impairment which is significant enough not to be able
to comply with oral
bisphosphonates, and where Strontium Ranelate cannot be used.
This may not
apply to patients with cognitive impairment who have supervised
medication regimes
eg care home residents.
2. In patients with significant malabsorption problems
3. In patients with extremely high bone turnover states such as
hyperparathyroidism
2nd/
3rd
line treatment
All other patients should be offered alendronate (unless
contra-indicated, or
inappropriate) as first line treatment for secondary prevention
of osteoporosis. For
those not able to tolerate alendronate, the patient should be
offered the choice of
another oral bisphosphonate or strontium ranelate as most
appropriate.
Patients not tolerating any of the above should be offered
referred to secondary careto potentially be offered zoledronic
acid.
