Zoledronic acid (5 mg) is used as an annual intravenous infusion for the treatment of post menopausal Osteoporosis, Paget's disease, Hypercalcaemia and more recently complex regional pain syndrome. Zoledronic acid is a potent anti-resorptive preparation used to slow bone breakdown, increase bone density and decrease the amount of Calcium released from the bones into the blood. Previously patients were reviewed in the outpatients clinic whereby bloods tests, Parathyroid hormone, Vitamin D, Bone profile, Urea and Electroyltes are routinely taken. Patients were then listed to have the infusion administered on a short stay ward over thirty minutes. Problems that had been encountered have meant that some patients had received the infusion without the blood results being available, this has lead to reports of hypocalcaemia due to Vitamin D deficiency. Further to this the Medicines and Healthcare products regulatory agency (MHRA) (April 2010) reported renal impairment with its use, of 139 worldwide suspected (14 fatal) cases. It was usually assocated with the first dose. As a consequence of this a protocol was developed for the staff on the short stay ward, training sessions were held for the staff and a flow chart was designed for use by the ward staff, the patients now have to have current blood results available before they are listed for the infusion. Staff were also empowered as they had a tool by which they could defer treatment and contact the relevant team members. All patients in the Hospital that require Zoledronic acid have to be referred to the specialist Osteoporosis nurses to ensure blood results are only up to two months old. If they are not available make arrangements for the blood tests to be carried out. Any patient with a low Vitamin D <20 ng/ml are prescribed and dispensed a course of Colecalciferol by the nurses and then checked to ensure they are Vitamin D replete. Patients with an eGFR <35 mls/min are referred to the metabolic and bone clinic for other treatment options to be discussed appropriately. This practice ensures that a safe and timely practice is provided for patients that require Zoledronic acid infusions that number approximately 300 patients per year.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.