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Zoledronic acid, which is according drug classes classifieds as bisphosphonate, its chemical formula {C5H10N2O7P2}, is an inhibitor for bone resorption and used in treating patients with cancer [1]. Zoledronic acid administered as an intravenous infusion. In treating bone metastases, it is considered the only (bisphosphonate) shows efficacy in patients with a many types of tumors and in multiple myeloma. It has a removal half-life equal 146 hours, has high affinity for hydroxyapatite, there is no metabolism and excreted by the kidney.
This report will clarify Zoledronic acids mechanism of action, indications, and side effects.
The bone is composed mainly of two components; 30% organic material (collagen type 1) and 70% inorganic material (hydroxyapatite which is responsible for the mineralization of bone). Zoledronic acid has high affinity toward hydroxyapatite , thus the majority of it binds to hydroxyapatite (mineralized bone) just within 24 hours after administration[4].
During bone resorption zoledronic acid is released from the surface of the bone and is taken by osteoclasts where it inhibits farnesyl pyrophosphate synthase (FPP synthase) which is a part of the mevalonate pathway that ends in the formation of several compounds including farnesyl pyrophosphate (FPP) and geranylgeranyl pyrophosphate (GGPP)[5] .
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As a result there will be no FPP and GGPP which are responsible for the prenylation* ( farnesylation and geranylgeranylation) of the small GTPases including both Ras GTPase and Rab GTPase , so both of them will be inhibited [5,6,7] .
Ras GTPase is important in the intracellular signaling pathways including cell proliferation, differentiation as well as apoptosis[9] , and Rab GTPase is important in the membrane adhesion on surfaces including bone[10] .
As a result we can conclude that zoledronic acid inhibits osteoclast’s function, prevents its proliferation and induces its apoptosis. *prenylation is the addition of prenyl group ( a hydrophobic group) to facilitate protein-protein and protein-cellular membrane interactions[8] .
Indications and usage for zoledronic acid Zoledronic acid as mentioned before, it decreases osteoclastic reabsorption, so it has a role in treatment of many bone disorders, like osteoporosis, also Paget disease by controlling the rapid turnover of bone, and hypercalcemia in malignancies such as breast cancer, prostate cancer, and multiple myeloma. It is preferred in postmenopausal osteoporosis for prevention of bone loss and bone fractures. [11] Even zoledronic acid help in hypercalcemia treatment, but it is contraindicated for usage in hyperparathyroidism or nontumor-related hypercalcemia. [12]
Also, zoledronic acid is given to reduce the effect of fractured bone, bone pain and in surgery for a patient with bone metastasis. Zoledronic acid is preferred in the treatment of cancer patients than pamidronic acid due to its comfortable way of administration also it has better results and compliance. [13]
Transient Flu-like symptoms such as fever, malaise, myalgia, headache, and arthralgia are the most common adverse effects, mainly after the first infusion , they are tend to occur because Zoledronic acid can activate gamma/delta T cells. Renal effects a study have shown that there is a transient increases in serum creatinine in 1.8% of ZOL patients and 0.8% of placebo patients within 10 days of dosing, and in all cases resolved without specific therapy [14] , also patients who receive Zoledronic acid infusion should be adequately hydrated before the administration of the drug , Zoledronic acid is contraindicated in patients with renal impairment creatinine clearance Osteonecrosis of the jaw a rare complication of Zoledronic acid that observed especially in multiple myeloma patients treated with Zoledronic acid who have had dental surgical procedures prior to the treatment.
Zoledronic acid belongs to the Bisphosphonates family, so it can lead to oversuppression of bone remodeling, causing atypical fractures in the femur particularly after long-term use (usually after more than 4 years).
Zoledronic acid is like any other drug in medicine it is subject to success and failure, so it is important to know when the drug is working to continue using it or if it is not we stop it because we will have only side effects without benefits. Zoledronic acid effect in treating post-menopausal osteoporosis was confirmed in 2007 by a trial that involved 7736 women with post- menopausal osteoporosis and out of these women 3875 received 3 annual injections of 5mg zoledronic acid and the rest received placebo, after three years of treatment 152 women were selected to obtain biopsies from the iliac crest and it was assessed by micro-CT scans which showed a median increase of 16% in Trabecular bone volume in zoledronic acid patients, in addition they developed increase in both trabecular number and thickness and a decrease in trabecular separation compared to placebo [17].
Zoledronic acid effect in reducing skeletal related effects in patients with bone metastasis of prostate cancer was established by a clinical trail, 214 patients received 4 mg zoledronic acid and 208 received placebo, those patients were evaluated by time to the first skeletal-related event, disease progression, pain and analgesia and urine biomarkers of bone metabolism, the research revealed a decrease in the percentage of occurrence of skeletal related events such as fractures in zoledronic acid group and a huge decrease in bone resorption markers in urine (N-telopeptide-, pyridinoline), but unfortunately pain was more in zoledronic acid group and the progression of the disease showed no difference among both groups [18].
Zoledronic acid is a bisphosphonate family .it used mainly in in osteoporosis and bone metastasis in prostate tumor, lung tumor, and other solid tumors. Preventing bone resorption by inhibit osteoclast activity, proliferation and induce apoptosis. It is safe for long-term use and provides durable treatment benefits but with risk of atypical fracture. Osteonecrosis of the jaw is rare and bad SE so we can use denosumab in case of multiple myeloma.
Zoledronic Acid: Prescription Patterns, Mechanisms, and Clinical Implications. (2024, Feb 15). Retrieved from https://studymoose.com/document/zoledronic-acid-prescription-patterns-mechanisms-and-clinical-implications
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