Zometa (Zoldronic acid) for osteopenia for PSC/AIH/UC patient

My son has some ongoing liver and bowel diseases (AIH/PSC and UC). Because he has been on prednisone (10 mg/day) for last 4 years, he has become osteopenic and his endocroniologist is recommending that he be given Zometa which is approved for hypocalcemia for cancer patients. The doc does not prefer Fosamax or other bisphosphonates as there is the likelihood of GI complications. We have read some info on Zometa but, given the possibility of complications/side effects, can not conclude if it is a good option to go for. Especially considering that our son has never had any bisphosphonate and because Zometa (4 mg via i.v.)goes directly into the blood may potentially cause more problems. There was only one clinical research study on Zometa, published last year in NEJM on postmenopausal osteoporosis women, but seems like more studies needs to be carried out before it be given (off label)for increasing BMD.  Could you please comment pro/con and make a recommendation?  Also, what are the chances of complications of Zometa with Prednisone, Urso, Imuran, and Colazal - all the medications he takes for his GI/and UC problems.  

Thanks.

Omega06

[Kevin Pho, MD]

Without being involved in the case, I cannot make any recommendations.  I can give some input on Zometa (i.e. Zolendronate).  It is typically more effective at a lower dose than pamidronate (which is the bisphosphonate of choice in treating hypercalcemia).  

In a pooled analysis of two separate phase III studies involving a total of 275 patients with tumor-induced hypercalcemia, a single dose of zolendronate (4 mg or 8 mg) normalized the corrected serum calcium level in 87 to 88 percent of patients, compared with only 70 percent of those receiving pamidronate (90 mg).  The median duration of control of hypercalcemia was longer for those receiving zolendronate (32 to 43 days) compared with 18 days for pamidronate. Zolendronate is administered over a shorter period of time (15 minutes) than pamidronate (2 hours). It is currently approved by the United States Food and Drug Administration for treatment of hypercalcemia of malignancy at a dose of 4 mg intravenously over at least 15 minutes.

Here are the drug interactions for this medication:
1) Aminoglycosides: Aminoglycosides may lower serum calcium levels with prolonged administration; concomitant use may have additive effect.

2) Loop diuretics: Increased risk of hypocalcemia with concomitant use

3) Thalidomide: Risk of renal dysfunction may be increased with concurrent use in patients with multiple myeloma.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Agus.  Treatment of hypercalcemia.  UptoDate, 2003.