Zoledronic acid Audit

Dr R Musa

Introduction

Zoledronic Acid Highly potent bisphosphonate

Developed for therapy of malignant hypercalcaemia

Major advantage once yearly IV infusion over 15 mins

IV route lowers risk of esophagitis seen with oral bisphosphonate

Licensed for postmenopausal osteoporosis

Reduce New Clinical Fracture

38% RRR 5% ARR NNT 20

13.9%

8.6%

Adverse Events

Atrial fibrillation (1.3% with ZA vs 0.5% with placebo)

Adverse events more common in treatment group than placebo group:

– Myalgias around infusion time (3.1 vs 0.9%)– Pyrexia around infusion time (6.9 vs 0.9%)

No reported cases of osteonecrosis of the jaw

Conduct of the Audit

The aims of the AuditTo evaluate the current practice of Zoledronic acid therapy at NNUH.

Methods: The Audit form prepared by Dr R Musa Data collected by the nurses in rheumatology day units The period from (March 2009 to June 2009) 4 months Total of (12 patients) attended for Zolendronic acid infusion 11 patients had the infusion

Indication for Aclasta

73 % osteoporosis

3% osteoporosis + Malignancies

3% Paget disease

3% Pathologic fracture

which osteoporosis therapy tried

IV Pamidronate (3)

Alendronic acid (5)

Ibandronate

Risedronate (1)

Actonel (1)

Have the information been explained to the patients

Have the information been explained to the patient

0

2

4

6

8

Yes(7) patients

No(2) patients

Do notKnow(2) patients

Has the patient been given oral calcium & Vitamin D

Yes (55%)

No(36%)

Do not know (3%)

Creatinine clearance > 40ml/min

02468

1012

11 patients One patientC.C < 35Not given ZA

All patients

have their

calcium level

Checked(100%)

5 patients Not told to drink more water

5 patients Told to drink more water

One patient Given tea

Has the patient been told to drink glass of water before the infusion

Observation for 20 min after the end of infusion

73% (Yes)

27 % (No)

YES (91%)

NO(9%)

Has the patient been informed that one third may develop flu like illness

Conclusion

1-make sure the indication for ZA in NNUH is for osteoporosis

2-patient already tried all usual Osteoporotic therapy before referral for ZA

3-information should be explained to patients and given leaflet during clinic time.

4-patients should be given adequate Vit D & Ca supplement before referral for ZA infusion

5-Creatinine clearance and Calcium level should be checked

6-patient should be told to drink adequate water before ZA infusion