Zoledronic Acid for Treatment of Low Bone Mineral Density in Patients with Beta Thalassemia Major

  • Rahul NaithaniEmail author
  • Tulika Seth
  • Nikhil Tandon
  • Jagdish Chandra
  • V. P. Choudhry
  • H. Pati
  • Renu Saxena
Original Article


To determine the efficacy of zoledronic acid (ZA) in thalassemia major associated low bone mineral density. Prospective, open label, single arm trial. Bone mineral density (BMD) at lumbar, hip and forearm region were performed at baseline and after 1 year of therapy. Initial, 9 patients received a first dose of 4 mg. Due to severe adverse effects, further doses for these patients and all new recruited patients were 1 mg once every 3 months for 4 doses. All patients were receiving 500 mg of calcium carbonate twice daily and 0.25 μg alfacalcidol once daily before and during the entire study period. Dual energy X-ray absoptiometry was performed at baseline and after 1 year. Twenty-seven patients with transfusion dependent thalassemia with a median age 19.5 year (15–38 years) were eligible for ZA treatment. Seven patients had bony pains. Four patients developed grade 4 hypocalcemia (3 developed tetany) and 2 developed infusion related toxicity with initial dose of 4 mg. One mg dose was well tolerated. At the end of 1 year, bone pains had completely resolved. There was significant increase in BMD at lumbar (p = 0.002) and forearm regions (p = 0.04) and intertrochantric area (p = 0.041). The % change in BMD at 1 year was +3.7 ± 3.2%. ZA is an efficacious agent in treatment of low BMD in these patients. ZA produces significant adverse reactions at 4 mg dose but 1 mg dose is well tolerated and is efficacious.


Thalassemia Osteoporosis Bisphosphonate 



Financial support was obtained from Shantha Biotech for DXA scans of these children. Zoledronic acid injections were provided by Shantha Biotech free of cost.

Compliance with Ethical Standards

Informed Consent

Informed consent was obtained from all individual participants included in the study. This was part of DM thesis.


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Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Department of HematologyAll India Institute of Medical ScienceNew DelhiIndia
  2. 2.Department of Endocrinology and MetabolismAll India Institute of Medical ScienceNew DelhiIndia
  3. 3.Department of PediatricsLady Hardinge Medical College and Kalawati Saran Children’s HospitalNew DelhiIndia
  4. 4.Division of Hematology and Bone Marrow TransplantationMax Superspeciality Hospital SaketNew DelhiIndia

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