Orbital inflammation following zoledronic acid infusion

Area of Science:

• Pharmacology
• Ophthalmology
• Rheumatology

Background:

• Bisphosphonates, including zoledronic acid, are crucial in treating bone diseases by inhibiting osteoclast activity.
• While generally safe, bisphosphonates can cause adverse effects, ranging from mild symptoms to severe complications like osteonecrosis of the jaw.
• Orbital inflammation (OI) is a rare but significant adverse effect associated with bisphosphonate therapy, presenting with ocular and orbital symptoms.

Purpose of the Study:

• To report a case of orbital inflammation (OI) following zoledronic acid infusion for osteoporosis.
• To discuss the diagnostic and treatment approach for this rare adverse event.
• To emphasize the importance of recognizing and managing OI in patients receiving bisphosphonates.

Main Methods:

• A case report detailing a 76-year-old male patient who developed OI after zoledronic acid infusion.
• Clinical presentation included eye pain, swelling, diplopia, chills, and vomiting.
• Diagnosis was confirmed by MRI and elevated inflammatory markers; treatment involved intravenous methylprednisolone followed by oral prednisone taper.

Main Results:

• The patient experienced significant symptom improvement within 12 hours of initiating corticosteroid treatment.
• Full resolution of orbital inflammation symptoms was achieved after a 7-week prednisone taper.
• No evidence of systemic infection or autoimmune disease was found.

Conclusions:

• Orbital inflammation is a rare but important potential adverse effect of zoledronic acid infusion.
• Corticosteroids appear effective in managing zoledronic acid-induced OI, though optimal treatment protocols require further investigation.
• Clinicians should maintain awareness of this adverse effect and consider standardized management strategies.