title: Seizures associated with zoledronic acid for osteoporosis.
abstract: BACKGROUND
  Bisphosphonates represent potent antiresorptive drugs that are established for therapy of patients with benign and malignant bone diseases. Zoledronic acid is an iv aminobisphosphonate that is administered annually against osteoporosis. Because of its potency and the parenteral route of administration, zoledronic acid is an alternative to oral bisphosphonates, in particular in elderly patients with multiple comorbidities. The most common side effects include an acute-phase reaction and mild and transient hypocalcemia.
  
  
  OBJECTIVE
  Here, we report three cases of seizures that developed after the administration of zoledronic acid.
  
  
  METHODS
  We review case histories and laboratory results of three patients with seizures associated with the administration of zoledronic acid. We discuss their course and comorbidities in the context of the published literature.
  
  
  RESULTS
  All three patients were elderly persons with multiple comorbidities, including neurological diseases, that required parenteral bisphosphonates for severe osteoporosis with concurrent contraindications for oral bisphosphonates.
  
  
  CONCLUSIONS
  We analyze potential mechanisms underlying these seizures in association with zoledronic acid exposure and discuss potential strategies to minimize this risk.
authors.affiliation: Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technical University Medical Center, D-01307 Dresden, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Tsourdi
authors.forename: Tilman D
authors.initials: TD
authors.lastname: Rachner
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruber
authors.forename: Christine
authors.initials: C
authors.lastname: Hamann
authors.forename: Tjalf
authors.initials: T
authors.lastname: Ziemssen
authors.forename: Lorenz C
authors.initials: LC
authors.lastname: Hofbauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy*; D012640:Seizures / Q000139:chemically induced*; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid