Background Zoledronate is recommended by European guidelines for the treatment of osteoporosis particularly where first-line oral drugs are ineffective or contraindicated. EULAR's guidelines are complimented by UK organisations including the National Institute of Health and Care Excellence (NICE), National Osteoporosis Guidelines Group (NOGG), British Society of Rheumatology (BSR) and the National Osteoporosis Society (NOS).
Objectives The aim of our audit was to ascertain whether our use of zoledronate was compliant with current guidelines and review the real life experience.
Methods We performed a retrospective audit of fifty patients who were commenced on zoledronate for the treatment of osteoporosis during 2012–2016 in our Trust. Data gathered included the reasons for commencement, whether patients had appropriate monitoring and the effect it had on DEXA and FRAX scores.
Results The age ranged from 44–88 years; 67% were between 60–80 years with 80% females. Vertebral fragility fractures were the most common type of fracture (42%). Zoledronate was commenced primarily because of either intolerance or inefficacy to oral anti-osteoporotic treatment (Table 1). It was commenced as first line in 20% because of contraindications to oral drugs. Almost 70% of our patients received zoledronate for two or three years. There was an improvement by 43% and 38% in the DEXA t-score for the spine and hip respectively. Stable t-scores were recorded for the spine and hip in 49% and 54% respectively, whereas 8% deteriorated. Three patients sustained a fragility fracture and a further 11 experienced side effects (Table 2); five patients consequently stopped treatment. Only 3% had recorded FRAX scores pre- or post-zoledronate treatment. All of our patients had their calcium and renal function measured before each zoledronate infusion whilst over 80% had their vitamin D checked. All of our patients had dental checks prior to treatment. Following post-treatment DEXA scans 46% continued zoledronate and 16% were on a drug-free holiday. A third were switched to denosumab due to ineffectiveness, side effects or contraindications.
Conclusions The majority of our patients had improvements or stability in bone mineral density T-scores with only 20% experiencing side effects. Our results show that the vast majority of our patients are treated with zoledronate in concordance with guidelines. Nonetheless we can make improvements in recording FRAX scores and monitoring vitamin D levels. This has been highlighted to the multidisciplinary osteoporosis team and changes have been instigated. We plan to re-audit in due course.
Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women J. ESCEO & IOF. Osteoporos Int. 2013; 24: 23–57.
Osteoporosis: Clinical guideline for prevention and treatment. NOGG. 2013.
Disclosure of Interest None declared