Severity of acute phase reaction in children receiving the first dose of zoledronic acid and the impact of the underlying condition: a cross-sectional study

Nayak S; Rayner L; Mughal Z; McKinney G; Mason A; Wong S.C; Padidela R; Chinoy A

doi:10.1530/ey.22.5.8

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ESPE Yearbook of Paediatric Endocrinology (2025) 22 5.8 | DOI: 10.1530/ey.22.5.8

ESPEYB25 5. Bone, Growth Plate and Mineral Metabolism Novel Treatments (6 abstracts)

5.8. Severity of acute phase reaction in children receiving the first dose of zoledronic acid and the impact of the underlying condition: a cross-sectional study

Nayak S , Rayner L , Mughal Z , McKinney G , Mason A , Wong S.C , Padidela R & Chinoy A

Archives of Disease in Childhood, (2024). 109(10), 849-853. https://doi.org/10.1136/archdischild-2023-326287

Brief Summary: This retrospective cross-sectional study examined the severity of the acute phase reaction (APR) experienced by 107 children following their first zoledronate infusion. Most patients experienced a mild APR that did not require overnight hospital admission; however, certain patient groups exhibited more severe reactions.

Commentary: Zoledronate, a widely used bisphosphonate for treating osteoporosis in children, is known to cause an acute phase reaction after the initial dose. This often leads to routine overnight hospital admissions for monitoring. While this approach is cautious, it contributes to significant healthcare costs and resource utilisation. This study addresses this issue by providing objective evidence on the severity of the APR, with the aim of informing more selective admission policies.

The study demonstrates that the APR is usually mild, enabling outpatient management in most cases and improving both resource allocation and patient experience. However, the study also identifies specific ’high-risk’ patient categories who may still benefit from inpatient monitoring due to more severe reactions, such as those with Duchenne muscular dystrophy, systemic inflammatory disorders/steroid-induced osteoporosis, and epilepsy. These findings enable a more individualised approach of patients treated with bisphosphonates.