title: First cases of calcium pyrophosphate deposition disease after zoledronic acid therapy.
abstract: A number of medications promote the development of calcium pyrophosphate deposition disease (CPDD). We report 2 cases of acute CPDD after intravenous zoledronic acid therapy. Case #1: a 63-year-old female was admitted for vertebroplasty at the site of an osteoporotic fracture. She received an intravenous infusion of zoledronic acid 5mg on the day after the procedure. Acute CPDD developed in her right knee 24hours later. Findings from joint aspiration and standard radiography confirmed the diagnosis. Case #2: this 79-year-old woman had a history of CPDD was on glucocorticoid and hydroxychloroquine therapy for lupus. She was given an intravenous infusion of zoledronic acid 5mg as prophylaxis of glucocorticoid-induced osteoporosis. Joint pain and a fever developed later on the same day. After 5 days, she had arthritis of the right wrist, laboratory evidence of systemic inflammation, and hypocalcemia. Radiographs showed evidence of CPDD. A Medline search identified 6 cases of bisphosphonate-related CPDD, including 2 due to pamidronate, 2 to etidronate, 1 to alendronic acid, and 1 to neridronic acid. The features were similar to those in our patients, with a short time to onset, systemic inflammation in many cases, a tendency toward hypocalcemia, and radiographs that often showed evidence of CPDD. Bisphosphonate-induced CPDD is a rare eventuality that should nevertheless be borne in mind by rheumatologists. Also, in patients with CPDD while taking bisphosphonate therapy, a role for the drug in the symptoms should be considered.
authors.affiliation: Service de rhumatologue, hôpital Pierre-Paul-Riquet, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse cedex, France. Electronic address: couture.guillome@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Couture
authors.affiliation: Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Inserm U1027, faculté de médecine, université Paul-Sabatier, CHU de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France.
authors.forename: Faustine
authors.initials: F
authors.lastname: Delzor
authors.affiliation: Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Inserm U1027, faculté de médecine, université Paul-Sabatier, CHU de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France.
authors.forename: Haleh
authors.initials: H
authors.lastname: Bagheri
authors.affiliation: Service de pharmacologie clinique et pharmacovigilance, centre d'informations sur le médicament et de pharmacovigilance Marseille Provence Corse, Aix-Marseille université, AP-HM, Marseille, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Micallef
authors.affiliation: Service de rhumatologue, hôpital Pierre-Paul-Riquet, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.affiliation: Service de rhumatologue, hôpital Pierre-Paul-Riquet, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Laroche
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002131:Calcium Pyrophosphate / Q000378:metabolism; D002805:Chondrocalcinosis / Q000139:chemically induced*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D002131:Calcium Pyrophosphate
keywords: Arthritis; Bisphosphonates; Calcium pyrophosphate deposition disease; Chondrocalcinosis; Pseudogout; Zoledronic acid