Hi everybody,
I am officially diagnosed with IgG low risk MGUS. My myeloma specialist wants to put me on 4 mg zoledronic acid (Reclast, Zometa) every 6 months for my osteoporosis.
After doing lots of reading about this medication, I have become very concerned about the side effects. Should I take it?
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Mojbahar - Name: M
- Who do you know with myeloma?: Self mgus
- When were you/they diagnosed?: Jully 2016
- Age at diagnosis: 48
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
Hi Mojbahar,
I am only aware of one study that was published the way your doctor has recommended using it zoledronic acid (Zometa, Reclast):
Berenson, JR, et al, "Zoledronic Acid Markedly Improves Bone Mineral Density for Patients with Monoclonal Gammopathy of Undetermined Significance and Bone Loss," Clinical Cancer Research, Oct 2008 (full text of article)
Excerpt from abstract:
"Results: At study end for all patients (N = 54), L-spine T-scores improved by a median of +0.27 (range, -0.38 to +3.91), corresponding to a median increase in bone mineral density of +15.0% (range, -18.0% to +1,140.0%; P < 0.0001). Hip T-scores improved by a median of +0.10 (range, -2.40 to +2.03), corresponding to a median increase of +6.0% (range, -350.0% to +165.0%). During the study, no new fractures, osteonecrosis of the jaw, or significant renal adverse events were reported.
Conclusions: Zoledronic acid administered i.v. at a dosage of 4 mg every 6 months for three doses total was well-tolerated and substantially improved bone mineral density for patients with MGUS and bone loss. Zoledronic acid may be effective for the prevention of new fractures in this high-risk population."
A potential benefit of zoledronic acid is that it can have a positive impact on the immune system. They can activate gammadelta T cells:
Kondo, M., et al, "Zoledronate facilitates large-scale ex vivo expansion of functional γδ T cells from cancer patients for use in adoptive immunotherapy," Cytotherapy, 2008 (abstract)
I have been taking zoledronic acid quarterly for a few years and I have been talking with my doctor about doing it three times per year. I have not had any side effects quarterly, but everyone is different and you are wise to be careful and research the drugs your doctor is discussing with you.
Best of luck moving forward.
Mark
I am only aware of one study that was published the way your doctor has recommended using it zoledronic acid (Zometa, Reclast):
Berenson, JR, et al, "Zoledronic Acid Markedly Improves Bone Mineral Density for Patients with Monoclonal Gammopathy of Undetermined Significance and Bone Loss," Clinical Cancer Research, Oct 2008 (full text of article)
Excerpt from abstract:
"Results: At study end for all patients (N = 54), L-spine T-scores improved by a median of +0.27 (range, -0.38 to +3.91), corresponding to a median increase in bone mineral density of +15.0% (range, -18.0% to +1,140.0%; P < 0.0001). Hip T-scores improved by a median of +0.10 (range, -2.40 to +2.03), corresponding to a median increase of +6.0% (range, -350.0% to +165.0%). During the study, no new fractures, osteonecrosis of the jaw, or significant renal adverse events were reported.
Conclusions: Zoledronic acid administered i.v. at a dosage of 4 mg every 6 months for three doses total was well-tolerated and substantially improved bone mineral density for patients with MGUS and bone loss. Zoledronic acid may be effective for the prevention of new fractures in this high-risk population."
A potential benefit of zoledronic acid is that it can have a positive impact on the immune system. They can activate gammadelta T cells:
Kondo, M., et al, "Zoledronate facilitates large-scale ex vivo expansion of functional γδ T cells from cancer patients for use in adoptive immunotherapy," Cytotherapy, 2008 (abstract)
I have been taking zoledronic acid quarterly for a few years and I have been talking with my doctor about doing it three times per year. I have not had any side effects quarterly, but everyone is different and you are wise to be careful and research the drugs your doctor is discussing with you.
Best of luck moving forward.
Mark
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Mark11
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
I believe the dose of zoledronic acid that you are being advised to take is in between the sort of dose that is given when myeloma patients receive Zometa therapy, and when people with osteoporosis take Reclast. Both Reclast and Zometa have zoledronic acid as the active ingredient. They are just sold under different names and in different doses and/or concentrations.
Given the reduced dose of zoledronic acid that you would take if you followed your specialist's advice, your risk of developing osteonecrosis of the jaw and other similar side effects is less than the risk most myeloma patients face taking Zometa. Most doctors consider that risk manageable as long as patients are cautious about dental procedures and damage to their jaw while being treated with Zometa.
There are a lot of discussions here in the forum about Zometa, bisphosphonates (the class of drugs it belongs to), and osteonecrosis of the jaw. Just go to the "Links to previous forum discussion" posting,
https://myelomabeacon.org/forum/links-existing-forum-discussions-t3780.html
at the top of the Treatments & Side Effects section of the forum, and go down through the list of links. You'll see separate links for Zometa, bisphosphonates, and osteonecrosis of the jaw.
Given the reduced dose of zoledronic acid that you would take if you followed your specialist's advice, your risk of developing osteonecrosis of the jaw and other similar side effects is less than the risk most myeloma patients face taking Zometa. Most doctors consider that risk manageable as long as patients are cautious about dental procedures and damage to their jaw while being treated with Zometa.
There are a lot of discussions here in the forum about Zometa, bisphosphonates (the class of drugs it belongs to), and osteonecrosis of the jaw. Just go to the "Links to previous forum discussion" posting,
https://myelomabeacon.org/forum/links-existing-forum-discussions-t3780.html
at the top of the Treatments & Side Effects section of the forum, and go down through the list of links. You'll see separate links for Zometa, bisphosphonates, and osteonecrosis of the jaw.
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
Hi Mojbahar,
Just wondering how that dosage you mentioned in this post went for you. I have just been advised the same dosage, with a possible start next week. I have smoldering myeloma with osteoporosis. I too have concerns about larger doses and the side effects. Has your osteoporosis improved with this lower dose?
Just wondering how that dosage you mentioned in this post went for you. I have just been advised the same dosage, with a possible start next week. I have smoldering myeloma with osteoporosis. I too have concerns about larger doses and the side effects. Has your osteoporosis improved with this lower dose?
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Sandi G - Name: Sandi G
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: June 2017
- Age at diagnosis: 59
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
I have been on Zometa for 4 years, monthly the first two years, and then quarterly thereafter. I probably will discontinue it altogether very soon. My first infusion of Zometa gave me a flu-like reaction about 36 hours post infusion, with fever and chills. I have not experienced any side effects since the first infusion. It is important to be well hydrated and insist that the infusion be administered over 45 minutes. Most people do not experience side effects from Zometa. Good luck
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Dano - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 65
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
Hi Dano,
Thanks for your feedback. Just a query. You said you may stop Zometa after 4 years. Is it common to stop this treatment? Is there a point where the bone heals and we no longer need it, or is this just your personal choice?
I'm now going to get Prolia (denosumab), not Zometa. I guess I thought I would need to continue taking it, but you've led me to think that down the track I may no longer need treatment for my bones, and possibly need to rethink Prolia as my choice.
Thanks for your feedback. Just a query. You said you may stop Zometa after 4 years. Is it common to stop this treatment? Is there a point where the bone heals and we no longer need it, or is this just your personal choice?
I'm now going to get Prolia (denosumab), not Zometa. I guess I thought I would need to continue taking it, but you've led me to think that down the track I may no longer need treatment for my bones, and possibly need to rethink Prolia as my choice.
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Sandi G - Name: Sandi G
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: June 2017
- Age at diagnosis: 59
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
I'm facing a similar situation and would appreciate any perspectives that might help me decide what to do.
I am (luckily, so far!) asymptomatic except that I have unexpected osteoporosis (T-score -2.5, FRAX scores all good and low risk of fracture.) Osteoporosis is what led to my smoldering myeloma diagnosis.
My doctor feels we should treat the osteoporosis since almost all multiple myeloma patients present with bone density issues and it will likely get worse. Instead of an oncology protocol, I had a Reclast infusion last Monday which is the same stuff as Zometa, but infused just once per year at 5 mg / 100 ml.
The side effects were disablingly painful for a week, which I wasn't prepared for! I'm not sure if they're gone or just teasing me with a little break.
My gut feeling is to "watch and wait" with the osteoporosis just as I am with the multiple myeloma. I really don't want Relast / Zometa infusions unless I really truly need them, not just because of the recent pain, but because of all of the warnings against using these drugs for any length of time. My reluctance to use them is why I ended up exploring the reason for my osteoporosis and not just starting on bisphosphonates 2 years ago, which was the gut reaction of my primary care physician.
Thoughts?
I am (luckily, so far!) asymptomatic except that I have unexpected osteoporosis (T-score -2.5, FRAX scores all good and low risk of fracture.) Osteoporosis is what led to my smoldering myeloma diagnosis.
My doctor feels we should treat the osteoporosis since almost all multiple myeloma patients present with bone density issues and it will likely get worse. Instead of an oncology protocol, I had a Reclast infusion last Monday which is the same stuff as Zometa, but infused just once per year at 5 mg / 100 ml.
The side effects were disablingly painful for a week, which I wasn't prepared for! I'm not sure if they're gone or just teasing me with a little break.
My gut feeling is to "watch and wait" with the osteoporosis just as I am with the multiple myeloma. I really don't want Relast / Zometa infusions unless I really truly need them, not just because of the recent pain, but because of all of the warnings against using these drugs for any length of time. My reluctance to use them is why I ended up exploring the reason for my osteoporosis and not just starting on bisphosphonates 2 years ago, which was the gut reaction of my primary care physician.
Thoughts?
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Defcon Dragon - Name: Defcon Dragon
- Who do you know with myeloma?: myself, smoldering
- When were you/they diagnosed?: October 2017
- Age at diagnosis: 55
Re: Zoledronic acid (Reclast, Zometa) for osteoporosis
My first indicator of myeloma was two compression fractures in my spine at age 59. This happened out of the blue. They were very painful and finally successfully treated with kyphoplasty. I have been on monthly 4 mg Zometa treatments for almost two years. I have no reaction from the Zometa, which is infused over 30 minutes. For me, the risks are outweighed by the benefit of stronger bones.
Good luck with your decision.
Linda
Good luck with your decision.
Linda
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LindaM - Name: Linda
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2016
- Age at diagnosis: 59
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