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Bisphosphonate (IV)

Zoledronic Acid

Brand names: Aclasta (once yearly), Zometa (oncology dosing)

Used in: Osteoporosis

Zoledronic acid is an intravenous bisphosphonate given as an infusion, used once yearly for osteoporosis and also in oncology. It reduces bone resorption and fracture risk.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Hypercalcemia of malignancy ( 2.1 ) 4 mg as a single-use intravenous infusion over no less than 15 minutes. 4 mg as retreatment after a minimum of 7 days. Multiple myeloma and bone metastasis from solid tumors. ( 2.2 ) 4 mg as a single-use intravenous infusion over no less than 15 minutes every 3 to 4 weeks for patients with creatinine clearance of greater than 60 mL/min. Reduce the dose for patients with renal impairment. Coadminister oral calcium supplements of 500 mg and a multiple vitamin containing 400 international units of vitamin D daily. Administer through a separate vented infusion line and do not allow to come in contact with any calcium or divalent cation-containing solutions. ( …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-09-18. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It is a nitrogen-containing bisphosphonate that binds bone mineral and inhibits osteoclast-mediated bone resorption.

Prescribing in practice

  • It is nephrotoxic, so avoid in significant renal impairment, ensure good hydration before the infusion and check renal function.
  • Correct hypocalcaemia and ensure adequate calcium and vitamin D before treatment.
  • A flu-like acute-phase reaction can follow the infusion; osteonecrosis of the jaw and atypical femoral fractures are recognised, so a dental check is advisable beforehand.

Monitoring

Check renal function and calcium/vitamin D status before each dose, ensure adequate hydration, and ask about thigh, hip or groin pain and dental or oral symptoms.

Counselling the patient

  • Flu-like symptoms (fever, aches) can occur in the days after the infusion and usually settle.
  • Drink plenty of fluids around the time of the infusion as advised.
  • Report new thigh, hip or groin pain, or jaw or mouth problems, and mention this medicine to your dentist.

Evidence & guidelines

Guideline-recommended intravenous bisphosphonate for osteoporosis (NICE).

Reference: NICE CG146; HORIZON Trial (NEJM 2007); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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