Certain factors make giving zoledronic acid to nursing home patients a complex proposition, he added. “The disadvantage is that it can have side effects, it can lower your calcium abruptly if you are not replete in calcium before you take it, and you also have to be replete in vitamin D. It has to be given slowly because the side effect that is most immediate is an achiness of the muscles and joints. In nursing homes, it’s hard to give a drug very slowly.”
Dr. Robert Lindsay, of Helen Hayes Hospital in West Haverstraw, New York, wrote a commentary accompanying the article. “I think they’re to be congratulated on getting this study done,” Dr. Lindsay told Reuters Health in a telephone interview. “It’s a very difficult environment in which to do clinical research, unless you can convince the management of the nursing home that there will be a benefit to their patients and a benefit that they can measure economically.”
In order to reduce fractures among frail older people, he added, clinicians must address non-skeletal risk factors as well, such as poor sight and hearing, which can override any potential bone-strengthening effect of medication. “Physicians need to treat patients, not bones,” he said.
Currently, Dr. Lindsay added, many nursing homes give frail patients intranasal calcitonin to treat osteoporosis. “It’s probably the weakest of the agents that we have,” he said. Given the apparently small effects of zoledronic acid, which is much more powerful, in these patients, intranasal calcitonin is unlikely to be beneficial, he added, and its use should be discontinued in nursing homes.
The National Institutes of Health and the Pittsburgh Older Americans Independence Center supported this research, and Novartis supplied the study medication for free. Three authors reported receiving support through their institutions from Amgen, Merck, Ortho Biotech, Eli Lilly, and Sanofi; no other authors reported any disclosures.
