Intravenous Zoledronic Acid (Aclasta)Treatment for Osteoporosis

What is osteoporosis?

• Osteoporosis is a thinning and weakening of the bones, which is common in women after the menopause. The earlier a woman reaches the menopause, the greater her risk of breaking bones due to osteoporosis.
• A broken bone following a simple fall after the age of 50 may be a sign of osteoporosis.
• Men with low testosterone levels are at an increased risk of developing osteoporosis.
• Many people with osteoporosis have no symptoms.

Why am I having this treatment?

• Zoledronic Acid is prescribed to treat your osteoporosis as you have an increased risk of fractures.
• This treatment helps prevent loss of bone density, consequently helping to rebuild bone and making fractures less likely.
• Zoledronic Acid can also be used to treat Paget’s disease of the bone.

What is Zoledronic Acid (Aclasta)?

Zoledronic Acid is a drug from a group of medicines called bisphosphonates which are used to treat osteoporosis. The treatment comes as an intravenous infusion, a drip, which will be given through a vein in your arm. This will take approximately 30 minutes and is given once every year.

Who carries out this treatment?

The specialist nurse in endocrinology is responsible for carrying out this treatment.

Zoledronic Acid treatment may be delayed/not used if you have any of the following health issues:

• if you have or have had low calcium levels in the past, the doctor may wish to give you calcium supplements prior to starting the treatment.
• if you have or have ever had kidney problems, kidney failure or have needed dialysis, or if you have any other disease that may affect your kidneys.
• if you have vitamin D deficiency, this may need to be treated before you receive Zoledronic Acid. The doctor or the endocrine specialist nurse will make this decision and arrange for treatment if required.
• if you are undergoing or may require dental treatment, your dentist will need to be informed that you are going to be treated with Zoledronic Acid. Before you receive this treatment tell your doctor or dentist if you have, or have had pain, swelling or numbness in your gums, jaw or both, if your jaw feels heavy, or if you have recently lost a tooth.

Where is the treatment carried out?

You will be sent a letter with the details of the treatment and which department that you will need to attend at the Bradford Royal Infirmary. You can bring someone with you to this appointment if you wish.

What happens before the treatment?

• The endocrine specialist nurse will contact you asking for details of your dentist and other relevant information regarding your dental care.
• Prior to your appointment, a letter will be sent to your GP and dentist advising them of your forthcoming treatment. If you are undergoing or may require dental treatment, it may be wise to have your dental work before you start Zoledronic Acid.
• You should have a blood test on receipt of your appointment letter. The endocrine specialist nurse will advise you what tests are required and where you can have your blood test taken.
• It is important to maintain good oral hygiene whilst being treated with Zoledronic Acid to help prevent tooth decay and gum disease. It is recommended that a mouth wash should be used for 5 days before and 5 days after the treatment. You can buy this from any supermarket or chemist.
• You may eat and drink as normal.
• You may take all your medication as usual.
• Please let the nurse know if you have recently broken your hip as it is recommended that Zoledronic Acid is administered two or more weeks after your hip repair/replacement surgery

What happens during the treatment?

• You will meet the endocrine specialist nurse who is in charge of the treatment on your arrival to the department. The nurse will explain all about the treatment. You will be given the opportunity to ask questions prior to you giving consent for this procedure.
• A cannula, a fine plastic tube, will be inserted into a vein in your arm. There may be some discomfort for a few seconds. This is used for the intravenous fluids.
• An intravenous infusion (a drip) of Zoledronic Acid will be given. This will take approximately 30 minutes.
• You will need to make sure you drink at least one or two glasses of fluid before and after the treatment. This will help to prevent dehydration. This is especially important in patient’s who take diuretics (water pills) and for elderly patients.

Are there any side effects?

• Like all medicines, Zoledronic Acid can cause side effects, although not everybody gets them.
• Zoledronic Acid may cause a drop in the levels of calcium in your blood.
• Common side effects which start within one day of the first injection are aches or pains in the muscles, bones or joints and flu-like symptoms. In most cases these symptoms are mild and will not need any treatment. Taking paracetamol may help relieve these symptoms. The symptoms should go away quickly, within two to three days of the injection.
• Other common side effects are heartburn, stomach ache, headache, fatigue, rash, diarrhoea, nausea, constipation, and back pain.
• Uncommon side effects are skin reactions at the injection site such as redness, pain and swelling of the veins.
• Rare side effects are tingling and swelling of the face, lips and mouth.
• Rarely an irregular heart rhythm may occur.
• If you feel dizzy during your Zoledronic Acid treatment, let the nurse know. Do not drive or use machines until you feel better.
• A very rare side effect is osteonecrosis of the jaw. This is a severe disease of the jawbone. If you get any problems with your teeth please see your dentist as soon as possible.
• A very rare side effect is osteonecrosis of the ear canal. If you get any ear problems following this treatment, please see your GP and inform the endocrine specialist nurse.
• Unusual fractures of the thigh bone may occur rarely. Contact your GP and inform the endocrine specialist nurse if you experience new or unusual pain in your hip, groin or thigh as this may be an early indication of a possible fracture of the thigh bone.

How long will the treatment take?

Please allow approximately one hour.

What happens after the treatment?

• At the end of the treatment the cannula will be removed and a small dressing applied, the dressing may be removed once you get home.
• On completion of the treatment you will be safe to return home or to work alone.
• The endocrine specialist nurse will plan for an appointment in one years time for your next treatment with blood tests beforehand. You will receive an appointment letter nearer the time.
• A repeat bone density scan (dexa scan) will be arranged by the medical staff after you have received approximately three years of this treatment. This is to see how effective your Zoledronic Acid treatment has been. The doctor will arrange this when you attend the endocrine clinic.
• You should take calcium and vitamin-D supplements while receiving Zoledronic Acid. If you are unable to do so, you should inform your doctor or the nurse.
• To get the most benefit from the treatment it is important to continue receiving the injections every year for as long as your doctor says it is necessary.
• If you have Paget’s disease it is possible that you may only require one dose. The endocrine specialist nurse will make sure an appointment is arranged for you to see the doctor in the endocrine clinic where your condition will be reviewed.
• If you experience any of the side effects or if you notice any side effects not listed in this leaflet please tell your endocrine specialist nurse, doctor or your dentist (if the side effect is related to your gums).

If you require more details please contact the Specialist Nurses in Endocrinology:
Tel: 01274 382019 Monday – Friday between 8.00am and 4.00pm except Bank Holidays