Osteoarthritis Flare-up Secondary to Zoledronic Acid Infusion: A Case Report

Zoledronic acid is commonly used to treat osteoporosis and it is generally well tolerated. We describe the case of a woman with osteoporosis, who developed a flare-up of osteoarthritis hours after receiving a single dose of zoledronic acid. She developed fever with chills, generalized body aches, and severe low back pain. This was followed by severe bilateral knee pain, wrist pain, and minor joint pain in the hands. Radiography revealed signs of osteoarthritis in the following joints: proximal and distal interphalangeal joints of the hands, trapeziometacarpal joint, patellofemoral, and medial tibiofemoral joint on both sides. Investigations excluded septic arthritis, gout arthritis, and systemic infection. A diagnosis of a flare-up of osteoarthritis secondary to zoledronic acid infusion was made. Symptomatic treatment and supportive care led to the patient's recovery. Treating physicians need to be aware of the possibility of such rare symptom flare-ups following zoledronic acid infusion.