Proinflammatory reaction to a bisphosphonate infusion in a patient with a reverse shoulder replacement and literature review

Abstract

Bisphosphonates are the first-line pharmacological treatment for osteoporosis due to their efficacy and low rate of self-limited adverse effects. Challenges in adherence to oral treatment has spurred the development of third-generation bisphosphonates that only require single annual infusion due to high potency and binding efficacy. The authors report the case of a woman in her 70s who presented with postoperative shoulder pain after zoledronic acid infusion. Diagnostic work-up revealed stable prosthesis with no signs of fracture, loosening or infection. Administration of oral steroids resulted in resolution of pain and return to baseline function. Acute postoperative joint pain attributed to bisphosphonate infusion has not been previously described in the literature. This case report and literature review suggests consideration of adverse inflammatory reaction due to bisphosphonate infusion in the setting of a patient presenting with joint replacement and acute exacerbation of pain without clear aetiology.

Giant cell arteritis associated with intravenous zoledronic acid administration

“…15–17 Although many of these cases represented a new inflammatory condition, 15 , 16 , 19 some reported flare-up of previously documented osteoarthritis ( n = 2) 17 , 18 or a postoperative shoulder joint. 20 …”