Background Intravenous-bisphosphonates (IVB) are effective and very widely used in treatment of osteoporosis. Prior inadequate serum 25 hydroxyvitamin-D (25OHD), before administering IVB could lead to rapid life-threatening hypocalcaemia1,2. Also, it is well known that to achieve optimal benefit of IVB adequate levels of vitamin-D are needed3.
Objectives We share our experience regarding exploration of checking vitamin-D status pre-administration of IVB in patients with osteoporosis.
Methods In this retrospective observational study, the electronic records of 408 patients with osteoporosis, attending a planned-short-stay-unit (PSSU) for IVB (i.e. zoledronate, pamidronate and ibandronate) in year 2009 were searched. 114 out of 408 patients were excluded due to incompletely recorded data; hence, data-set on rest 294 patients was retrieved which was exported to excel sheets and analysed regarding type of bisphosphonates, pre-bisphosphonate vitamin D level status and the referring speciality.
Results These 294 patients attended PSSU for 636 infusions over a period of one-year; where 112/294 (38%) had annual zoledronate, 52/294 (18%) had 6-monthly pamidronate and 130/294 (44%) had 3-monthly ibandronate leading to 112, 129 and 395 infusions respectively. These 636 infusions were requested by various specialities; where majority 431/636 (68%) were from metabolic-bone-clinic, 129/636 (20%) from rheumatology and 64/636 (10%) from gastroenterology, whereas only 12/636 (2%) were referred from combined geriatrics, endocrinology, general-medicine and nephrology units.
In zoledronate group pre-IVB vitamin-D status were assessed in 102/112 (91%) patients; where majority patients i.e. 97/102 (95%) were replete and the remaining 5/102 (5%) were thereby administered vitamin-D. However, amongst the pamidronate group vitamin-D status was checked only in 67/395 (17%) pre-IVB infusion episodes; where 42/67 (63%) were replete. Furthermore, amongst ibandronate group repletion such status was checked only in 25/129 (19%) infusions, where 9/25 (36%) were vitamin-D replete.
Conclusions Overall, in less than one-third (194/636) infusions pre-IVB vitamin-D status was checked and only 23% were vitamin-D replete pre-IVB. Amongst the rest, in just over two-third infusions (442/636) vitamin-D levels were not examined at all. This retrospective analysis illustrates, that there is further scope for improvement in checking vitamin D repletion status prior to administering IVB, especially in pamidronate and in bandronate group. Perhaps, this is of utmost important amongst zoledronate group, where life-threatening hypocalcaemia have been previously reported1,2.
Rosen CJ, Brown S. Sever hypocalcaemia after intravenous bisphosphoinate therapy in occult vitamin D deficiency. New Engl J med 2003;348:1503-4.
Pete R, Mishra V, Fraser WD. Sever hypocalcaemia after being given intravenous bisphosphonates. Br Med J 2004;328:335-6.
Novartis. Zometa (Zoledronic acid) injection prescribing information. East Hanover, NJ;2005 Apr.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.