Patients with any of the following clinical features would be considered for treatment with zoledronic acid:
Upper gastrointestinal abnormalities, including oesophageal stricture, achalasia, abnormalities which delay
oesophageal emptying, dysphagia, oesophageal disease (oesophagitis, ulcers, erosions), gastritis, duodenitis,
gastric ulcers, previous upper GI surgery.
Inability to sit or stand upright for at least 30 minutes.
Zoledronic acid is suitable in the above patient cohorts except patients with renal impairment (eGFR <35ml/min).
Concerns about compliance with treatment – may include patients with cognitive impairment.
For patients with corticosteroid induced osteoporosis the LSCMMG has agreed that the choice of denosumab or zoledronic acid should be based on the clinical judgement of the responsible clinician.