Just One Dose Bolstered Elderly Bones

Cullen Care Pharmacy owner said zoledronic acid may lead to progress in osteoporosis treatment

(RxWiki News) A single dose of one osteoporosis medication may be enough to help patients — even those who are very frail.

A new study found that zoledronic acid may improve bone mineral density in the frail elderly living in long-term care facilities. In fact, a single dose may be effective for up to two years.

For about eight years, zoledronic acid (brand name Reclast) has been approved by the US Food and Drug Administration to treat postmenopausal women who have osteoporosis. Osteoporosis is a disease that causes bones to become weak and brittle. While it affects both men and women, older women who have gone through menopause face the highest risk, according to the National Osteoporosis Foundation. Zoledronic acid has been effective in past research at strengthening bones and protecting against fractures.

Susan L. Greenspan, MD, of the Division of Geriatric Medicine at the University of Pittsburgh’s Department of Medicine, led this study.

“We found that a single infusion of zoledronic acid in frail, cognitively challenged, less mobile elderly women improved bone density and reduced bone turnover [the natural replenishing of old bone with new bone] for two years,” Dr. Greenspan and team wrote. “This suggests that even a very frail cohort may benefit.”

James H. Dykes, RPh, owner of Cullen Care Pharmacy in Houston, TX, told dailyRx News that "Any treatment that helps the highest-risk older patients is worth looking into. Zoledronic acid may represent great progress in osteoporosis treatment."

Dr. Greenspan and colleagues followed 181 women with osteoporosis for two years. Patients were 65 years old or older and lived in a nursing home or assisted living facility. They included women with cognitive (mental) impairment, immobility and multiple medical conditions.

A total of 89 women received a single 5-milligram dose of zoledronic acid, and 92 were given a placebo (fake treatment). All patients took daily vitamin D and calcium supplements.

Dr. Greenspan and team measured hip and spine bone mineral density (BMD) at 12 and 24 months. BMD tells how much calcium and other types of minerals are in an area of bone. These researchers also recorded falls and other adverse events.

For those getting the zoledronic acid, average total hip BMD rose 2.8 percent at 12 months — compared to a 0.5 percent drop in the placebo group. At the two-year mark, hip BMD climbed 2.6 percent for the treatment group. It declined by 1.5 percent for the placebo group.

Similarly, average spine BMD also increased more for those who had the medication.

There were no significant differences in the number of deaths, fractures or heart disorders between the two groups, Dr. Greenspan and team found.

In an editorial about this study, Robert Lindsay, MB, ChB, PhD, of Helen Hayes Hospital in West Haverstraw, NY, wrote, “This draws attention to the need for large controlled clinical trials to determine if a combination of fall prevention strategies and treatment with bone-active drugs might produce additive benefits on fractures, especially in high-risk populations such as those living in nursing homes.”

The study and editorial were published online April 13 in JAMA Internal Medicine.

The National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, the Clinical Translational Science Institute and the National Center for Research Resources funded this research. Dr. Greenspan received grants from Amgen and Eli Lilly. Other authors received support from Merck, Ortho Biotech and Sanofi.

Review Date: 
April 12, 2015