Treatment of postmenopausal osteoporosis, patient perspectives – focus on once yearly zoledronic acid

Oral bisphosphonates are of proven efficacy in preventing fractures in postmenopausal osteoporosis. However, poor adherence limits their real-world efficacy and clinical utility. Zoledronic acid (ZOL) is a potent bisphosphonate administered by annual intravenous infusion, effectively ensuring adherence to therapy over the following year. According to available data, 66% to 79% of patients have expressed a preference for ZOL over oral bisphosphonates. This is likely to lead to enhanced clinical outcomes, although long-term (repeat annual) adherence is currently unknown. ZOL is of proven efficacy, with hip fracture reduction of 41% and morphometric vertebral fracture reduction of 70% over 3 years in the HORIZON PFT trial. It has demonstrated a good side-effect profile with postinfusion flu-like symptoms being the most common. Additionally, it has been associated with decreased mortality in patients following surgery for hip fracture. There is no clear association between exposure and the rate of serious or nonserious atrial fibrillation. We review adherence to oral bisphosphonates, and the pharmacokinetics, efficacy, safety, and patient preference for ZOL.