Efficacy of zoledronic acid in peri-menopausal women with osteopenia

A significant proportion of bone loss per year occurs starting around 1-3 years before menopause. A number of fractures occur in the osteopenic range of bone mineral density (BMD). There are no recommendations for the treatment of osteopenic peri-menopausal women. We conducted this study to explore the utility of zoledronic acid in preserving bone health in this population.

This is a prospective single-blinded randomized controlled trial. A total of 60 peri-menopausal women and 30 postmenopausal women with osteopenia were enrolled. The peri-menopausal women were randomized to receive either zoledronic acid or placebo in a 1:1 ratio. All postmenopausal osteopenic women received zoledronic acid. Participants were followed up for 12 months. BMD and bone turnover markers (BTM) were assessed.

At the end of 12 months, there was a significant increase in lumbar spine BMD in the peri-menopausal and postmenopausal groups which received zoledronic acid. On further subcategorizing the T-score, the improvement in BMD was statistically significant in the group with a T-score of - 1.75 to - 2.5. In peri-menopausal women with osteopenia with a T-score of - 1.75 to - 2.5, a single infusion of zoledronic acid increased lumbar spine and femoral neck BMD and suppressed the high bone turnover. Zoledronic acid thus could be used for preserving bone density and preventing the risk of osteoporosis and fragility fractures in the future.