Experts Speak Out: Once-a-Year Injection for Osteoporosis

A new option in the treatment of osteoporosis could one day change the way many of the 10 million Americans living with the bone-weakening condition are treated by doctors.

Research published in the current issue of the New England Journal of Medicine shows that a drug called Zometa (also known as Reclast), which is currently used in the treatment of metastatic bone cancer, also prevents bone loss through osteoporosis.

Patients taking the drug in the trial experienced a 70 percent reduced risk of fractures to the vertebrae, a 41 percent reduced risk of hip fracture and an overall improvement in bone density.

But what really sets the treatment apart from current options is the fact that it's a 15-minute, once-a-year IV procedure — a tempting prospect for many patients who cannot stomach the oral medications that are currently available.

But the treatment may come with risks as well; some of the patients taking the treatment experienced atrial fibrillation — an abnormal, potentially dangerous heart rhythm disorder.

Here's what experts had to say about the possible benefits — and side effects — of this possible future treatment:

Dr. Steven Cummings
Senior Author
Emeritus Professor of Medicine and Epidemiology
University of California at San Francisco
San Francisco, Calif.

Only about one-third of patients continue to take oral treatments as long as one year. Giving one infusion a year guarantees compliance which, in turn, increases the effectiveness of treatment -- like an airbag instead of seat belts.

Dr. C. Conrad Johnston Jr.
Distinguished Professor of Medicine
Indiana University School of Medicine
Indianapolis, Ind.

This clinical trial of zolendronic acid demonstrates very good reduction in fracture risk with relatively few side effects. Most important, this therapeutic approach could significantly reduce the poor adherence found with oral agents. It is an important addition to our armamentarium to fight osteoporosis.

Dr. Lawrence Raisz
The University of Connecticut Center for Osteoporosis
Hartford, Conn.

The issue of atrial fibrillation is important and will mean the patients need to be warned and monitored.

Dr. Brian William Walsh
Director, Division of Surgical Gynecology
Brigham and Women's Hospital
Boston, Mass.

An excellent study — well designed, adequately powered, showing statistically and clinically significant reductions in fracture rates. [Reclast] is potentially a breakthrough for the treatment of osteoporosis.

Dr. Robert Neer
Director, MGH Osteoporosis Center
Massachusetts General Hospital
Boston, Mass.

Neither the manuscript nor the editorial discuss why atrial fibrillation was more serious, but not more frequent, in zoledronate-treated patients. Was the atrial fibrillation more symptomatic, or accompanied by lower blood pressure or faster ventricular rate in zoledronate-treated patients? If not, in what way was the atrial fibrillation more often "serious"? Unless these data are reported more completely, they cannot be judiciously interpreted.

J. Edward Puzas
Professor of Orthopaedics
University of Rochester School of Medicine and Dentistry
Rochester, N.Y.

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