Osteoporosis is a diffuse skeletal disorder characterized by decreased bone strength and a resultant increased risk of fracture. Zoledronic acid is a biphosphonate that is prescribed to patients with osteoporosis and preserved kidney function (glomerular filtration rate > 30 ml/min). We are reporting the case of an 80-year-old female with poly osteoarthritis who developed an aseptic osteomyelitis of the right hip two days after receiving a perfusion of zoledronic acid administered for the management of her osteoporotic fracture (with vertebral collapse at L1). Although minor secondary effects such as flu symptoms are reported following perfusions of zoledronic acid, the occurrence of osteomyelitis in this context remains unexplained. Spontaneous resolution was noted a few weeks later and with the administration of nonsteroidal anti-inflammatory drugs.
References
[1]
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis Prevention, Diagnosis, and Therapy. JAMA, 285, 785-795. https://doi.org/10.1001/jama.285.6.785
[2]
Briot, K., Cortet, B., Thomas, T., Audran, M., Blain, H., Breuil, V., et al. (2012) Actualisation 2012 des recommandations françaises du traitement médicamenteux de l’ostéoporose post-ménopausique. Revue du Rhumatisme, 79, 264-274. https://doi.org/10.1016/j.rhum.2012.02.006
[3]
Black, D.M., Delmas, P.D., Eastell, R., Reid, I.R., Boonen, S., Cauley, J.A., et al. (2007) Once-yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. New England Journal of Medicine, 356, 1809-1822. https://doi.org/10.1056/nejmoa067312
[4]
Deng, H.O., Li, D.F., Zhang, W.J., Zhi, X.M., Xu, L. and Wu, W. (2011) Factors Associated with Acute Febrile Reaction in Elderly Patients Receiving Intravenous Zoledronic Acid for Osteo-Porosis. Journal of Southern Medical University, 31, 2076-2078.
[5]
Sykiotis, A., Papaioannou, G., Mavropoulos, J., Triantaphyllopoulou, M., Papandroulaki, F., Ktena, V., et al. (2013) Markers of Inflammation after Zoledronic Acid Redosing. Journal of Bone and Mineral Metabolism, 32, 72-77. https://doi.org/10.1007/s00774-013-0467-4
[6]
Dicuonzo, G., Vincenzi, B., Santini, D., Avvisati, G., Rocci, L., Battistoni, F., et al. (2003) Fever after Zoledronic Acid Administration Is Due to Increase in TNF-α and IL-6. Journal of Interferon & Cytokine Research, 23, 649-654. https://doi.org/10.1089/107999003322558782
[7]
de Jaeger, C. and Cherin, P. (2011) L’arthrose: Une nouvelle maladie inflammatoire? Actualités fondamentales et thérapeutiques. Médecine & Longévité, 3, 116-136. https://doi.org/10.1016/j.mlong.2011.04.001
[8]
Munier, A., Gras, V., Andrejak, M., Bernard, N., Jean-Pastor, M., Gautier, S., et al. (2005) Zoledronic Acid and Renal Toxicity: Data from French Adverse Effect Reporting Database. Annals of Pharmacotherapy, 39, 1194-1197. https://doi.org/10.1345/aph.1e589
[9]
Martel-Pelletier, J. and Pelletier, J.P. (1989) Molecular Basis for the Action of Tiaprofenic Acid on Human Osteoarthritic Cartilage Degradation: Protective Effects of NSAID. Seminars in Arthritis and Rheumatism, 18, 19-26. https://doi.org/10.1016/0049-0172(89)90080-2
[10]
van den Berg, W.B. (2001) Uncoupling of Inflammatory and Destructive Mechanisms in Arthritis. Seminars in Arthritis and Rheumatism, 30, 7-16. https://doi.org/10.1053/sarh.2001.23704
[11]
Scheller, E.L., Hankenson, K.D., Reuben, J.S. and Krebsbach, P.H. (2011) Zoledronic Acid Inhibits Macrophage SOCS3 Expression and Enhances Cytokine Production. Journal of Cellular Biochemistry, 112, 3364-3372. https://doi.org/10.1002/jcb.23267