An Old Drug (Zoledronate) Offers New Hope Against Osteoporosis

Weakened bones are a very big deal. If an older person falls and breaks a hip the outcome can be grim. There is pain. There is also lack of mobility. That can lead to blood clots that migrate from legs to lungs. A pulmonary embolism is a life-threatening event. Even when patients get excellent care there can be many other complications after a hip fracture, including death (World Journal of Orthopedics, Sept. 18, 2014).  That’s why prevention is essential to avoid weakened bones and fractures. A new study involving the old drug zoledronate (Reclast) suggests that it can be beneficial.

The New Study:

Osteoporosis is usually treated with bisphosphonates such as alendronate, but questions about safety and long-term effectiveness have discouraged doctors from prescribing such drugs as frequently as they once did. Now a carefully done study from New Zealand shows that older women with bone loss can benefit from treatment with zoledronate, an injectable bisphosphonate (New England Journal of Medicine, online Oct. 1, 2018).

The scientists recruited 2000 women at least 65 years old with osteopenia (weakened bones – pre-osteoporosis). Over the course of six years, these volunteers got injections every 18 months of zoledronate or placebo. At the end of the study, significantly fewer of the women getting zoledronate had fragility fractures in their spines or elsewhere in their bodies.

An Interview on NPR:

Rob Stein conducted an interview with researchers who were not involved in the study (All Things Considered, Oct. 1, 2018). Here is a transcript with one guest:

“This is an extremely important paper,” says Dr. Ethel Siris, a Columbia University medical professor who specializes in thinning bones and wasn’t involved in the study. “We now know that we have a therapy that has been shown to be highly effective.”

“This could prevent a lot of fractures,” says Siris, who is on the board of trustees of the National Osteoporosis Foundation. “And preventing fractures in people in this age range not only prevents a lot of suffering but also saves a lot of money.”

Zoledronate Side Effects:

This drug is not without side effects. Because patients get an intravenous infusion once a year or once every 18 month, the drug has long-lasting activity. Symptoms to be aware of include:

• Arthritis pain, muscle pain, bone pain, arm or leg pain, back pain
• Headache
• Dizziness
• High blood pressure
• Digestive distress (heartburn, nausea, diarrhea, vomiting, abdominal pain)
• Flu-like symptoms, fever, fatigue
• Kidney damage

The Bottom Line on the New Research:

The investigators are enthusiastic about the potential for this treatment to reduce fractures among older women, but they caution that these findings should not be applied to women under 65 years old. And of course it is important to eat lots of green leafy vegetables and exercise!

(New England Journal of Medicine, online Oct. 1, 2018)

Share your own experience with zoledronate (Reclast) in the comment section below.