Zoledronic acid infusion beneficial in the prevention and treatment of glucocorticoid-induced osteoporosis

January 01, 0001

Zoledronic acid infusion beneficial in the prevention and treatment of glucocorticoid-induced osteoporosis

Persistent use of glucocorticoid drugs is associated with bone loss and increased fracture risk. Concurrent oral bisphosphonates increase bone mineral density and reduce frequency of vertebral fractures, but are associated with poor compliance and adherence. The researchers from the UK, Belgium, USA, France, Switzerland and Australia aimed to assess whether one intravenous infusion of zoledronic acid was non-inferior to daily oral risedronate for prevention and treatment of glucocorticoid-induced osteoporosis. This 1-year randomised, double-blind, double-dummy, non-inferiority study of 54 centres in 12 European countries, Australia, Hong Kong, Israel, and the USA, tested the effectiveness of 5 mg intravenous infusion of zoledronic acid versus 5 mg oral risedronate for prevention and treatment of glucocorticoid-induced osteoporosis. 833 patients were randomised 1:1 to receive zoledronic acid (n=416) or risedronate (n=417). Patients were stratified by sex, and allocated to prevention or treatment subgroups dependent on duration of glucocorticoid use immediately preceding the study.

Zoledronic acid was non-inferior and superior to risedronate for increase of lumbar spine bone mineral density in both the treatment (least-squares mean 4.06% vs 2.71%, mean difference 1.36%, significant) and prevention (2.60% vs 0.64%, 1.96%, significant) subgroups at 12 months. Adverse events were more frequent in patients given zoledronic acid than in those on risedronate, largely as a result of transient symptoms during the first 3 days after infusion. Serious adverse events were worsening rheumatoid arthritis for the treatment subgroup and pyrexia for the prevention subgroup.

The researchers concluded: "A single 5 mg intravenous infusion of zoledronic acid is non-inferior, possibly more effective, and more acceptable to patients than is 5 mg of oral risedronate daily for prevention and treatment of bone loss that is associated with glucocorticoid use."

An important alternative for this increasing problem.


For the full abstract, click here.

The Lancet 373(9671):1253-1263, 11 April 2009
© Elsevier Ltd 2010
Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. David M Reid, Jean-Pierre Devogelaer, Kenneth Saag et al for the HORIZON investigators. Correspondence to David Reid: [email protected]

Category: M. Musculoskeletal, T. Endocrine/Metabolic/Nutritional, HSR. Health Services Research. Keywords: zoledronic acid, risedronate, prevention, treatment, glucocorticoid, induced, osteoporosis, multicentre double blind double dummy randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 23 April 2010

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