Effect of Zoledronic Acid Treatment on Muscle Mass in Osteoporosis Patients

25 Nov, 24

Introduction

Sarcopenia and osteoporosis increase the likelihood of falls, potentially resulting in fragility fractures like hip fractures, which are life-threatening and associated with high morbidity and mortality. In postmenopausal osteoporotic women, zoledronic acid increases bone mass and has been linked to a significant reduction in the risk of vertebral, hip, and nonvertebral fractures, but its clinical effect on muscle has remained unknown.

Aim

To investigate how zoledronic acid monotherapy affected muscle mass in osteoporosis patients

Patient Profile

Osteoporosis patients with T-score of < -2.5 obtained from bone mineral density (BMD) tests at the lumbar spine, femur neck, or total hip

Methods

Case–control, retrospective cohort study
The study included patients from an osteoporosis database and were divided into two groups
- Research group: Patients treated with 5mg zoledronic acid infusion once a year for three years and were evaluated using dual-energy X-ray absorptiometry (DXA) (n=113)
- Control group: Patients who didn't recieve any anti-osteoporotic medicines for three years and were similarly assessed using DXA (n=118)
At the fourth-year, appendicular skeletal muscle mass (ASM) and appendicular skeletal muscle mass index (ASMI) were assessed using DXA.
The changes in muscle mass between the groups were analyzed and compared.

Results

The change in muscle mass and BMD over three years was compared after adjusting for height and weight, as well as the baseline value of each item.
The research group receiving zoledronic acid demonstrated significant improvements in ASM, ASMI, and BMD, as shown in below Table.
The research group’s skeletal muscle mass increased by 841 g in ASM and 0.35 kg/m² in ASMI after three years, while decreased in the control group.
After three years, improvements in ASM and ASMI were positively correlated with BMD in the zoledronic acid-treated group (r=0.227, P=0.02), while no significant association was observed in the control group (r=0.119, P=0.10).

Table 1: Comparison of Changes in Muscle Mass and BMD

Change after 3.6 Years (SD 0.3)	Zoledronic Acid (N = 113)	Control (N = 118)	Difference Between- Group^b
Difference in ASM, g, mean (SD)	+841 (905)	−107 (1309)	P=0.01^b
	P<0.001^a	P=0.12^a
Difference in ASMI, kg/m², mean (SD)	+0.35 (0.69)	−0.154 (0.546)	P=0.03^b
	P=0.002^a	P=0.21^a
Difference in BMD, g/cm², mean (SD)
Lumbar spine	+0.083 (0.043)	−0.007 (0.021)	P=0.01^b
	P<0.001^a	P=0.14^a
Femoral neck	+0.047 (0.015)	−0.012 (0.017)	P=0.03^b
	P<0.001^a	P=0.03^a

^aThe paired t-test revealed a difference when compared to the baseline.

^bA t-test was used to compare groups.

Abbreviations: BMD, Bone Mineral Density; ASM, appendicular skeletal muscle mass; ASMI, appendicular skeletal muscle mass index; SD, standard deviation.

Conclusion

In addition to enhancing BMD in patients with osteoporosis, three years of zoledronic acid treatment may also lead to an increase in appendicular skeletal muscle mass index.

Reference

Drug Design, Development and Therapy 2021:15 3711–3715