ZOLEDRONIC ACID IN METASTATIC BONE DISEASE: AN AUDIT BASED DISCUSSION
Abstract
Background: Metastatic bone disease is a common problem in patients with advanced cancer causingsignificant morbidity and poor quality of life. Effective and less toxic treatments, like bisphophonates, canreduce morbidity in such cases. Objectives: The objectives of this study were to determine whetherZoledronic acid was administered in accordance with current recommendations for its prescribing and toproduce protocols for improved patient outcomes. Methods: The study was a retrospective audit of 39consecutive patients with metastatic bone disease secondary to solid tumours who were treated withZoledronic acid. The records were analysed to establish the administered dose of Zoledronic acid relativeto creatinine clearance. The standards for Zoledronic acid therapy were defined from best practiceguidelines. Results: The commonest diagnosis in patients receiving Zoledronic acid was carcinomaprostate 19/39 (49%) followed by carcinoma breast 11/39 (28%), gastrointestinal malignancies 4/39(10%) and renal cell carcinoma 3/39 (8%). Indications for therapy were metastatic bone disease alone 31(79%), hypercalcaemia alone 0/39 (0%), metastatic bone disease with hypercalcaemia 5/39 (13%), andprevention of chemotherapy induced bone loss 1/39 (3%). The dose of Zoledronic acid was appropriate tothe creatinine clearance in 25/39 (64%), inappropriate in 5/39 (13%) and unclear from the notes in 9/39(23%). Conclusions: Majority of patients received Zoledronic acid for the appropriate indications. Thedose of Zoledronic acid was appropriate to serum creatinine clearance in a majority of patients. Poordocumentation of data pertaining to Zoledronic acid treatment is observed which can potentially lead tomajor errors in prescribing. We recommend using a standard form to document each episode of therapywith Zoledronic acid.Keywords: Zoledronic Acid, Metastatic Bone Disease, AuditReferences
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