Department of Public Health, Helsinki University, Mannerheimintie 172, 00300, Helsinki, Finland.
Department of Orthopedics and Traumatology, North Kymi Hospital, 45750, Kuusankoski, Finland.
J Med Case Rep. 2022 Dec 16;16(1):473. doi: 10.1186/s13256-022-03695-y.
Zoledronic acid is an intravenous, highly potent aminobisphosphonate for use in patients with primary or secondary osteoporosis. Zoledronic acid-induced prolonged side-effects are well known and quite common. However, severe side-effects can be a threat to life. We report a case of severe side-effects induced by zoledronic acid infusion, and its positive effect on long-term back pain.
In 2012, a 62-year-old white native Finnish woman was operated on for an estrogen and progesterone receptor-positive breast cancer. After radiotherapy, an aromatase inhibitor (letrozole) was started. Nine months after the operation, the patient suffered a low-energy compression fracture of Th XII. She received denosumab to prevent fragility fractures and to improve bone mineral density. Letrozole was discontinued after 5.5 years, and the last denosumab injection was given after 7 years. Six months later, at the age of 71 years, the patient received a single intravenous zoledronic acid infusion. Suddenly, at 10 hours from the infusion, she complained of severe trismus, muscle twitching, spasms, and tingling, matching hypocalcemia and several other symptoms. Her serum 25-hydroxyvitamin D concentration was high (163 nmol/L), the concentration of serum calcium and calcium-ion was normal (2.32 mmol/L and 1.23 mmol/L, respectively). However, the neutrophil to lymphocyte ratio (NLR) was low (1.6). A complete recovery took 2 months. Zoledronic acid infusion also had a positive effect: for many years, the patient had suffered low back pain and strain, which came to an end after this single infusion.
It is important that the potential patients receive sufficient information about the possibility of side-effects following the administration of intravenous zoledronic acid. To ensure that a zoledronic acid infusion is given as safely as possible, the safety information should include that the patient should not be left without monitoring for a minimum 24 hours after the infusion. Being alone and experiencing serious side-effects may lead to acute cardiac problems. Furthermore, the chronic low back pain and strain that our patient suffered for many years has clearly reduced for 16 months after infusion, so far. We conclude that this is a positive effect of zoledronic acid.
唑来膦酸是一种用于原发性或继发性骨质疏松症患者的静脉内、高效能的氨基双膦酸盐。唑来膦酸诱导的长期副作用是众所周知且相当常见的。然而，严重的副作用可能对生命构成威胁。我们报告一例唑来膦酸输注引起的严重副作用病例，并探讨其对长期背痛的积极影响。
2012 年，一位 62 岁的白人芬兰女性因雌激素和孕激素受体阳性乳腺癌接受手术治疗。放射治疗后，开始使用芳香酶抑制剂（来曲唑）。术后 9 个月，患者发生第十二胸椎低能量压缩性骨折。她接受地舒单抗预防脆性骨折和改善骨密度。来曲唑在 5.5 年后停药，最后一次地舒单抗注射在 7 年后。6 个月后，71 岁时，患者接受单次静脉唑来膦酸输注。输注后 10 小时，患者突然出现严重牙关紧闭、肌肉抽搐、痉挛和刺痛，伴有低钙血症和其他一些症状。她的血清 25-羟维生素 D 浓度较高（163nmol/L），血清钙和钙离子浓度正常（分别为 2.32mmol/L 和 1.23mmol/L）。然而，中性粒细胞与淋巴细胞比值（NLR）较低（1.6）。完全恢复需要 2 个月。唑来膦酸输注也有积极影响：多年来，患者一直遭受腰痛和劳损，单次输注后这些症状都得到了缓解。
向可能接受静脉唑来膦酸治疗的患者提供充分的关于药物副作用的信息非常重要。为确保静脉唑来膦酸输注尽可能安全，安全性信息应包括输注后至少 24 小时内患者不应无人监测。独自出现严重副作用可能导致急性心脏问题。此外，我们的患者在输注后 16 个月内，多年来一直持续的慢性腰痛和劳损明显减轻，目前为止仍如此。我们认为这是唑来膦酸的积极影响。
