Recently, the FDA approved the use of Reclast (zoledronic) acid for the treatment of osteoporosis. The bisphosphonate medication, known as Reclast, works by interfering with the process of bone breakdown as the drugs Fosamax, Boniva and Actonel do. Zoledronic acid, however, only needs to be administered once a year, and since it is taken intravenously, it avoids the gastrointestinal side effects of the oral formulations. The following information may be helpful if you decide to discuss with your physician whether this new osteoporosis treatment option might be right for you.
What happens when you take Reclast?
The entire process takes about half an hour. “It’s like drawing someone’s blood,” says Dr. Benjamin Lechner, a South Florida rheumatologist who administers zoledronic acid, or Reclast, regularly in his office. (Before the FDA approval for osteoporosis, zoledronic acid was available to treat other conditions. Dr. Lechner would contact the insurance companies of osteoporosis patients he believed could benefit from the medication and ask them to approve Reclast treatment on a case-by-case basis.)
At Dr. Lechner’s office, patients receive the infusion in a comfortable black chair stationed next to an IV pole. The patient’s arm is swabbed with iodine or alcohol, and a needle is inserted in the arm and taped securely. The plastic bag with Reclast medication is then hung from the pole and allowed to drip out over about half an hour. While not especially pleasant, Dr. Lechner says that the procedure is by no means excruciating - patients often flip through magazines or chat on cellphones as they wait for the bag to empty.
What about potential side effects of Reclast?
Because zoledronic acid is administered intravenously, patients do not experience the irritation of the esophagus, heartburn and other gastrointestinal problems sometime associated with bisphosphonates taken by mouth. However, studies have shown that receiving the bisphosphonate intravenously increases the risk of atrial fibrillation, or an abnormal heart rhythm.
As with all bisphosphonates, osteonecrosis - or dead bone tissue - of the jaw is a rare but serious potential side effect. Symptoms can include toothache, loose teeth, jaw pain, recurrent infections in the soft tissue, and failure of the jaw to heal normally after an extraction or other procedure.
In his practice, Dr. Lechner has observed about 10 percent of patients suffering from an achy, flu-like feeling the day following an infusion of zoledronic acid. He recommends Tylenol and says the discomfort subsides after about 24 hours. “This is a particularly safe drug,” says Dr. Lechner. “The side effects we know about have been made available, and we warn people.”
What is the long-term prognosis?
Dr. Lechner has observed patients improve their bone density six to eight percent in the year after treatment with zoledronic acid, and considers the medication to have prevented countless fractures. “We certainly have seen good results,” says Dr. Lechner, who adds that the drug often has a positive effect on patient’s attitude and well being as the risk of a life-threatening fracture is reduced. “They have that confidence knowing that they’ve done something good for their bones, and they don’t have to be afraid,” he says.