Turkish Journal of Physical Medicine and Rehabilitation 2016 , Vol 62 , Num 3

Should the cardiac rhythm be monitored following administration of zoledronic acid in elderly osteoporotic women?

Aliye Yıldırım Güzelant 1 ,Ayşe Banu Sarıfakıoğlu 1 ,İbrahim Yılmaz 2 ,Şeref Alpsoy 3 ,Gamze Varol Saraçoğlu 4 ,Nicel Taşdemir 5
1 Department of Physical Medicine and Rehabilitation, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
2 Clinical Pharmacologist, Pharmacist, Department of Pharmacovigilance, Materiovigilance, and Raitonal Use of Drugs, State Hospital, Ministry of Health, Republic of Turkey, Tekirdağ, Turkey
3 Department of Cardiology, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
4 Department of Public Health, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
5 Department of Obstetrics and Gynecology, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
DOI : 10.5606/tftrd.2016.78871 Objectives: This study aims to investigate the possible undesirable cardiac effects associated with zoledronic acid treatment in elderly osteoporotic women.

Patients and methods: Between October 2010 and December 2013, a total of 33 osteoporotic female patients (mean age 73.3±6.9 years; range 65 to 85 years) were included in this prospective study. Bone mineral density of the patients was measured. Biochemical and hormonal analyzes were performed. Electrocardiograms were taken. These analyses were repeated twice at one hour and 10 days after the administration of the zoledronic acid.

Results: Pre- and post-treatment electrocardiography findings within the first hour were found to be within normal limits. P-wave dispersion and RR intervals, which were found to be normal before administration of the drug, tended to significantly increase at 10 days following the administration (p=0.029 and p=0.031, respectively). Using a cut-off value of 50 msec, alterations in corrected QT dispersion were found to be statistically significant (p=0.004).

Conclusion: Based on our study findings, an increased ventricular arrhythmia risk should be also possibly considered as well as well-known atrial arrhythmic adverse effects of zoledronic acid. Therefore, we recommend a thorough examination for cardiac arrhythmia before the drug administration. Keywords : Adverse effect; cardiac arrhythmia; osteoporosis; toxicity; zoledronic acid