Orbital inflammatory disease secondary to a single-dose administration of zoledronic acid for treatment of postmenopausal osteoporosis

Abstract

A 60-year-old woman received a single 5-mg dose of zoledronic acid (Aclasta) for treatment of postmenopausal osteoporosis. One day after receiving the drug, she acutely developed a painful periorbital swelling, chemosis, and hyperemia in the right eye. The condition worsened despite initial treatment with topical steroids. An orbital CT scan showed right eye proptosis, eyelid edema, and intraorbital fat stranding. A diagnosis of orbital inflammatory disease was made, and the patient was treated with high-dose oral steroids (prednisone 80 mg/day) tapered along 6 weeks. The symptoms and the swelling reduced progressively after initiating oral prednisone, and after 12 days, there was complete resolution of the condition. The patient remained symptom free and had no remission after the treatment interruption.

Zoledronic acid: clinical utility and patient considerations in osteoporosis and low bone mass

“…Very few cases of posterior scleritis and anterior uveitis complicating zoledronic acid therapy have been reported 97–101. Ocular complications are idiosyncratic, and may occur shortly after, or weeks, months, or even years after the initiation of bisphosphonate therapy 61,102. Given the potential implications of these conditions, urgent ophthalmologic referral is recommended for patients who present with eye symptoms.…”

A 55‐year‐old woman with orbital inflammation

“…We performed a PubMed search using the terms “orbital inflammation” and “bisphosphonate” together, reviewed all references of pertinent articles, and identified 17 cases of acute bisphosphonate‐induced orbital inflammation published in the English literature (18–32) (Table 3). We also garnered additional cases from the National Registry of Drug‐Induced Ocular Side Effects (http://www.eyedrugregistry.com) located at the Casey Eye Institute in Portland, Oregon.…”

Sex Disparities in Neuro-Ophthalmologic Disorders

“…On a much smaller scale, bisphosphonates have been shown to cause ocular inflammation, such as anterior uveitis, conjunctivitis episcleritis, and scleritis, 151 and orbital inflammation in a small number of cases. [152][153][154][155][156][157][158][159][160][161][162][163][164] Bisphosphonates are primarily used for the treatment of osteoporosis. The use of bisphosphonates is increasing partly because of the increased use of aromatase inhibitors for the treatment of hormone-receptor-positive breast cancer in women and androgen-deprivation therapy for prostate cancer in men, which results in a reduction of bone-density.…”