title: Managing bone health with zoledronic acid: a review of randomized clinical study results.
abstract: OBJECTIVE
  To systematically review randomized, controlled clinical trials for managing osteoporosis, cancer treatment-induced bone loss, and bone metastases from breast cancer using zoledronic acid (ZOL).
  
  
  METHODS
  A systematic review of published literature and meeting abstracts was conducted to examine the efficacy of ZOL dosing strategies in clinical trials of osteoporosis, adjuvant therapy for breast cancer, and bone metastases from breast cancer. Bone resorption rates, tumor burden, skeletal health goals, and clinical data were considered when assessing ZOL in each setting.
  
  
  RESULTS
  Dosing schedules vary between approved indications for osteoporosis and bone metastases and the investigational use in women receiving endocrine therapy for BC, taking into consideration the different levels of bone loss and tumor burden in each setting. Gradual bone loss in healthy postmenopausal women with osteopenia or osteoporosis can be prevented or treated with the approved biennial or annual ZOL (5 mg), respectively. Rapid bone loss in patients receiving adjuvant chemotherapy and/or endocrine therapy for early-stage BC and low tumor burden is managed in the clinical setting with ZOL 4 mg every 6 months. In patients with bone metastases, very high tumor burden, high bone resorption levels, and decreases in bone integrity are managed by the approved ZOL schedule (4 mg every 3-4 weeks) to prevent skeleton-related events.
  
  
  CONCLUSIONS
  Dosing schedules are based on clinical evidence and vary depending on goals of therapy, rate of bone loss, and tumor burden. ZOL 5 mg every 12 months and every 24 months are approved for osteoporosis and osteopenia, respectively, whereas ZOL 4 mg every 6 months has been used during adjuvant endocrine therapy and ZOL 4 mg every 3-4 weeks is approved for managing bone metastases.
authors.affiliation: Philipps University of Marburg, Universitatsklinikum Giessen und Marburg, Baldingerstrasse, Marburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hadji
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D018488:Bone Demineralization, Pathologic / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000378:metabolism; D001859:Bone Neoplasms / Q000378:metabolism / Q000556:secondary*; D001862:Bone Resorption / Q000188:drug therapy* / Q000378:metabolism; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D004164:Diphosphonates / Q000008:administration & dosage / Q000378:metabolism; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000378:metabolism; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000378:metabolism; D017698:Postmenopause / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D000077211:Zoledronic Acid
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid