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Safety of Zoledronic Acid in Patients with Thalassemia Associated Low Bone Mineral Density

  • Rahul Naithani
  • Tulika Seth
  • Nikhil Tandon
  • Jagdish Chandra
  • H. Pati
  • V. P. Choudhry
Correspondence

To the Editor,

Zoledronic acid (ZA) is effective in thalassemia associated low bone mineral density [1, 2, 3]. We have recently documented 75–100% incidence of osteoporosis in Indian patients with thalassemia [4].

We performed a prospective study to assess the safety of ZA in patients with transfusion dependent thalassemia with osteoporosis/osteopenia. The Institute’s ethics committee approved the study. Twenty-seven patients (17 males) with median age of 18 years (16–38 Years) were enrolled. All patients were receiving 500 mg of calcium carbonate twice daily and 0.25 μg alfacalcidol once daily. Reconstituted ZA diluted with 100 ml of 0.9% w/v sodium chloride solution was given as a 15-min intravenous infusion.

With first dose of 4 mg ZA, 4 patients developed grade 4 hypocalcemia and 3 developed tetany (Table  1). All 4 patients were treated with intravenous calcium gluconate. Joint swelling with pain and fever were present in another patient, which started 24 h after the drug...

Notes

Acknowledgement

Financial support was obtained from Shantha Biotech for DXA scans and zoledronic acid for these patients.

Compliance with Ethical Standards

Conflict of interests

All the authors declares that they have no conflict of interests.

Informed Consent

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

References

  1. 1.
    Otrock ZK, Azar ST, Shamseddeen WA, Habr D, Inati A, Koussa S et al (2006) Intravenous zoledronic acid treatment in thalassemia-induced osteoporosis: results of a phase II clinical trial. Ann Hematol 85(9):605–609CrossRefPubMedGoogle Scholar
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    Perifanis V, Vyzantiadis T, Tziomalos K, Vakalopoulou S, Garipidou V, Athanassiou-Metaxa M et al (2007) Effect of zoledronic acid on markers of bone turnover and mineral density in osteoporotic patients with beta-thalassaemia. Ann Hematol 86(1):23–30CrossRefPubMedGoogle Scholar
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    Voskaridou E, Christoulas D, Konstantinidou M, Tsiftsakis E, Alexakos P, Terpos E (2008) Continuous improvement of bone mineral density two years post zoledronic acid discontinuation in patients with thalassemia-induced osteoporosis: long-term follow-up of a randomized, placebo-controlled trial. Haematologica 93(10):1588–1590CrossRefPubMedGoogle Scholar
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    Naithani R, Seth T, Tandon N, Chandra J, Pati H, Saxena R et al (2017) Fractures and low bone mineral density in patients with beta thalassemia major. Indian J Hematol Blood Transfus. doi: 10.1007/s12288-017-0820-1 Google Scholar
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    Maalouf NM, Heller HJ, Odvina CV, Kim PJ, Sakhaee K (2006) Bisphosphonate induced hypocalcaemia: report of 3 cases and review of literature. Endocr Pract 12:48–53CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Haematology & Transfusion Medicine 2017

Authors and Affiliations

  1. 1.Hematology and Bone Marrow Transplantation UnitMax Superspeciality HospitalSaket, New DelhiIndia
  2. 2.Department of HematologyAll India Institute of Medical ScienceNew DelhiIndia
  3. 3.Department of Endocrinology and MetabolismAll India Institute of Medical ScienceNew DelhiIndia
  4. 4.Division of Pediatric Hemato-Oncology, Department of PediatricsLady Hardinge Medical College and Kalawati Saran Children’s HospitalNew DelhiIndia

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