Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 9/2023

15-06-2023 | Lymphopenia | Case Report

Zoledronic acid–induced severe lymphopenia

Author: Savaş Karpuz

Published in: Osteoporosis International | Issue 9/2023

Login to get access

Abstract

Although anemia, thrombocytopenia, and mild lymphopenia have been reported in the acute phase response after zoledronic acid, severe lymphopenia has not been reported. This article describes a case of severe lymphopenia following a 5 mg zoledronic acid infusion administered to treat osteoporosis. Zoledronic acid is used to treat osteoporosis, hypercalcemia, Paget’s disease, and solid malignancies, including multiple myeloma, breast cancer, and prostate cancer. An acute phase response can be seen in 42% of patients after zoledronic acid treatment. Acute phase response may be accompanied by short-term spontaneously recovered anemia, thrombocytopenia, and severe lymphopenia.
Literature
1.
Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822CrossRefPubMed
2.
Dicuonzo G, Vincenzi B, Santini D, Avvisati G, Rocci L, Battistoni F et al (2003) Fever after zoledronic acid administration is due to increase in TNF-alpha and IL-6. J Interferon Cytokine Res 23(11):649–654CrossRefPubMed
3.
Lu K, Shi Q, Gong YQ, Li C (2022) Association between vitamin D and zoledronate-induced acute-phase response fever risk in osteoporotic patients. Front Endocrinol (Lausanne) 13:991913CrossRefPubMed
4.
Wark JD, Bensen W, Recknor C, Ryabitseva O, Chiodo J 3rd, Mesenbrink P et al (2012) Treatment with acetaminophen/paracetamol or ibuprofen alleviates post-dose symptoms related to intravenous infusion with zoledronic acid 5 mg. Osteoporos Int 23(2):503–512CrossRefPubMed
5.
Chen FP, Fu TS, Lin YC, Lin YJ (2021) Addition of dexamethasone to manage acute phase responses following initial zoledronic acid infusion. Osteoporos Int. 32(4):663–670CrossRefPubMed
6.
Silverman SL, Kriegman A, Goncalves J, Kianifard F, Carlson T, Leary E (2011) Effect of acetaminophen and fluvastatin on post-dose symptoms following infusion of zoledronic acid. Osteoporos Int 22(8):2337–2345CrossRefPubMed
7.
Murdoch R, Mellar A, Horne AM, Billington E, Chan PL, Gamble GD et al (2023) Effect of a three-day course of dexamethasone on acute phase response following treatment with zoledronate: a randomized controlled trial. J Bone Mineral Res 38(5):631–638CrossRef
8.
Reid IR, Gamble GD, Mesenbrink P, Lakatos P, Black DM (2010) Characterization of and risk factors for the acute-phase response after zoledronic acid. J Clin Endocrinol Metabol 95(9):4380–4387CrossRef
9.
Mariani S, Muraro M, Pantaleoni F, Fiore F, Nuschak B, Peola S et al (2005) Effector gammadelta T cells and tumor cells as immune targets of zoledronic acid in multiple myeloma. Leukemia 19(4):664–670CrossRefPubMed
10.
Black DM, Reid IR, Napoli N, Ewing SK, Shiraki M, Nakamura T et al (2022) The interaction of acute-phase reaction and efficacy for osteoporosis after zoledronic acid: HORIZON pivotal fracture trial. J Bone Miner Res 37(1):21–28CrossRefPubMed
11.
Adami S, Bhalla AK, Dorizzi R, Montesanti F, Rosini S, Salvagno G et al (1987) The acute-phase response after bisphosphonate administration. Calcif Tissue Int 41(6):326–331CrossRefPubMed
12.
Bijvoet OL, Frijlink WB, Jie K, van der Linden H, Meijer CJ, Mulder H et al (1980) APD in Paget's disease of bone. Role of the mononuclear phagocyte system? Arthritis Rheum 23(10):1193–1204CrossRefPubMed
13.
Kulkarni P, Cushman T, Donthireddy V, Rao S (2016) Spontaneously recovered severe thrombocytopaenia following zoledronic acid infusion for osteoporosis. Case Reports 2016:bcr2015213786
14.
Ferretti G, Petti M, Carlini P, Zeuli M, Picardi A, Meloni G et al (2004) Zoledronic acid-associated thrombotic thrombocytopenic purpura. Ann Oncol 15(12):1847–1848CrossRefPubMed
15.
Rossini M, Adami S, Viapiana O, Tripi G, Zanotti R, Ortolani R et al (2013) Acute phase response after zoledronic acid is associated with long-term effects on white blood cells. Calcif Tissue Int 93(3):249–252CrossRefPubMed
16.
Cui M, Zhang N, Zhang G, Han L, Yu LZ (2021) Investigation of intravenous zoledronic acid therapy on circulating lymphocyte subpopulation in patients with primary osteoporosis: a pilot study. Curr Ther Res 94:100634CrossRefPubMedPubMedCentral
17.
Psomadakis C, Creamer A, Baynes C (2016) Carbimazole-induced pancytopaenia. Br J Hosp Med 77(4):248–249CrossRef
18.
Watanabe N, Narimatsu H, Noh JY, Yamaguchi T, Kobayashi K, Kami M et al (2012) Antithyroid drug-induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Graves' disease. J Clin Endocrinol Metabol 97(1):E49–E53CrossRef
19.
Nehara HR, Gupta BK, Parmar S, Kumar V, Sihag D, Beniwal S (2020) Antithyroid drug-induced pancytopenia followed by acute lymphoblastic leukemia: a rare case. Thyroid Res Pract 17(3):149–151CrossRef
Metadata
Title
Zoledronic acid–induced severe lymphopenia
Author
Savaş Karpuz
Publication date
15-06-2023
Publisher
Springer London
Published in
Osteoporosis International / Issue 9/2023
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-023-06831-6

Other articles of this Issue 9/2023

Osteoporosis International 9/2023 Go to the issue

Original Article

Acromegaly and the long-term fracture risk of the vertebra and hip: a national cohort study

Original Article

Low bone mineral density, a neglected condition in North Africa and Middle East: estimates from the Global Burden of Disease Study, 1990–2019

Review

Osteoporosis medication adherence tools: a systematic review

Position Paper

Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

Original Article

The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients

Original Article

Relationships between longitudinal changes in body composition and bone mineral density in middle-to-older aged Australians