Clinical experience with intravenous zoledronic acid in the treatment of male osteoporosis: evidence and opinions

Abstract

Osteoporosis frequently remains underrecognized and undertreated in men. Most osteoporosis-related fractures could be prevented if men at risk would be diagnosed, treated, and remained compliant with therapy. Bisphosphonates, the mainstay of osteoporosis treatment, are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and likely improve survival in men with osteoporosis. The focus of the article is on intravenous zoledronic acid, which may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, polypharmacy, significant gastrointestinal pathology or suspected medication noncompliance. Zoledronic acid is approved in the United States (US) and European Union (EU) as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy. This article reviews the evidence for zoledronic acid, currently the most potent bisphosphonate available for clinical use, and its therapeutic effects in the treatment of men with osteoporosis.

Analysis of the time-to-onset of osteonecrosis of jaw with bisphosphonate treatment using the data from a spontaneous reporting system of adverse drug events

“…Gender was reported as a demographic and systematic risk factor for BRONJ [ 17 ]. BRONJ is rare in male patients with osteoporosis [ 18 ]. For oral BPs, the number of reports of BRONJ in males was lower than that in females (Table 1 ).…”

Denosumab versus bisphosphonates in patients with advanced cancers-related bone metastasis: systematic review and meta-analysis of randomized controlled trials

“…pyrophosphate analogs; bind hydroxyapatite in bone thus inhibits osteoclast activity. However, IV bisphosphonates are contraindicated in renal impairments as they may cause renal toxicity and acute-phase reactions [5,6].…”

Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials

“…Ibandronate is a nitrogen-containing BPs and IV injection of it allows for a dosing interval even longer than 2 months [59]. Zoledronate is another nitrogen-containing BPs that has the highest potency among clinical use BPs [60]. According to our result, 5 mg/year iv injection of zoledronate could significantly reduce the risk of secondary OVCF.…”