Zoledronic acid is a commonly used drug in orthopedics for the treatment of osteoporosis. Its common adverse reactions include: fever (18.1%), myalgia (9.4%), flu-like symptoms (7.8%), arthralgia (6.8%), and headache (6.5%), most of which occur within 3 days after administration. The vast majority of these symptoms are mild to moderate and resolve within 3 days after the adverse events appear. The incidence of these symptoms significantly decreases with subsequent use of the drug. If necessary, acetaminophen or ibuprofen can be taken shortly after administration, which can reduce the incidence of post-administration symptoms during the first 3 days by approximately 50%.
Mechanism of Zoledronic Acid-Induced Fever
Bisphosphonates inhibit osteoclast activity by blocking the conversion of isopentenyl pyrophosphate (IPP) to farnesyl pyrophosphate (FPP) in osteoclasts. At the same time, the accumulation of large amounts of prenylated phosphates stimulates the proliferation of γδT lymphocytes, producing large quantities of inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interferons (IFN). These factors trigger inflammatory responses, causing acute adverse reactions such as fever.