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Bisphosphonate

Zoledronic Acid

Brand names: Aclasta (osteoporosis), Zometa (oncology)

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: NOGG Osteoporosis Guidelines 2021; NICE TA160; 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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