Background Bisphosphonates (oral alendronate and risedronate, and intravenous zoledronate) are effective agents for glucocorticoid-induced osteoporosis (GIOP). Zoledronate is a convenient and highly compliant treatment compared to other bisphosphonates. In this study, we aimed to compare the efficacy, patient satisfaction, and preference of zoledronate with other bisphosphonates.
Methods We included 50 patients diagnosed with GIOP during treatment for autoimmune diseases including systemic lupus erythematosus (SLE). All patients had new fractures or persistent osteoporosis in follow-up bone densitometry after taking oral bisphosphonates for at least 1 year. After 1 year of treatment with zoledronate, a face-to-face survey was conducted on patients’ preference and satisfaction. The treatment efficacy was analyzed by comparing the changes in bone density and fractures with patients maintaining oral bisphosphonates as controls.
Results Patients with SLE and rheumatoid arthritis were included, with a mean age of 64.1 years (96% were female), and the mean duration of GIOP of 5.5 years. There was no difference in the cumulative glucocorticoid doses of the two groups. There were no significant differences in the treatment efficacy between zoledronate and oral bisphosphonate; annualized percentage change in bone density in the lumbar spine (1.9±3.91g/cm2 vs. 1±5.3g/cm2, p=0.355), femur neck (-0.91±6.31g/cm2 vs. 0.41±5.07g/cm2, p=0.264), and hip (0.29±2.91g/cm2 vs. 0.41±5.07g/cm2, p=0.888). The incidence of new fractures was two in each of the two groups, showing no difference. As a result of the survey, 39 patients (78%) preferred intravenous zoledronate over oral bisphosphonates and had higher satisfaction, and the most common reasons were administration interval and convenient regimen. The infusion-related adverse events of zoledronate were only 2 patients (4%).
Conclusions The patient reported preference and satisfaction of zoledronate were significantly higher than that of oral bisphosphonates, and the treatment efficacy for osteoporosis was similar. Therefore, zoledronate is recommended as a proper treatment for GIOP in patients with autoimmune disease including SLE.
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