title: Zoledronic acid in metastatic bone disease: an audit based discussion.
abstract: BACKGROUND
  Metastatic bone disease is a common problem in patients with advanced cancer causing significant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, can reduce morbidity in such cases.
  
  
  OBJECTIVE
  The objectives of this study were to determine whether Zoledronic acid was administered in accordance with current recommendations for its prescribing and to produce protocols for improved patient outcomes.
  
  
  METHODS
  The study was a retrospective audit of 39 consecutive patients with metastatic bone disease secondary to solid tumours who were treated with Zoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relative to creatinine clearance. The standards for Zoledronic acid therapy were defined from best practice guidelines.
  
  
  RESULTS
  The commonest diagnosis in patients receiving Zoledronic acid was carcinoma prostate 19/39 (49%) followed by carcinoma breast 11/39 (28%), gastrointestinal malignancies 4/39 (10%) and renal cell carcinoma 3/39 (8%). Indications for therapy were metastatic bone disease alone 31 (79%), hypercalcaemia alone 0/39 (0%), metastatic bone disease with hypercalcaemia 5/39 (13%), and prevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate to the creatinine clearance in 25/39 (64%), inappropriate in 5/39 (13%) and unclear from the notes in 9/39 (23%).
  
  
  CONCLUSIONS
  Majority of patients received Zoledronic acid for the appropriate indications. The dose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poor documentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead to major errors in prescribing. We recommend using a standard form to document each episode of therapy with Zoledronic acid.
authors.affiliation: Department of Acute and General Medicine, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, NE63 9JJ, United Kingdom. ali1334@hotmail.com
authors.forename: Raza Ali
authors.initials: RA
authors.lastname: Akbar
authors.forename: S K
authors.initials: SK
authors.lastname: Gosh
authors.forename: S
authors.initials: S
authors.lastname: Khalil
authors.forename: Sheikh Moeen
authors.initials: SM
authors.lastname: ul Haq
mesh_terms: D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D001862:Bone Resorption / Q000517:prevention & control*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D004282:Documentation; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009369:Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D003404:Creatinine; D002118:Calcium