Fanconi Syndrome After a Single Exposure to Intravenous Zoledronic Acid

Bisphosphonates are commonly used to reduce fracture risk in patients with osteoporosis, in those with malignant metastatic bone disease and for treatment of malignant hypercalcaemia. We present the case of a woman in her 80s admitted with recurrent falls who developed Fanconi syndrome after a single dose of intravenous Zoledronic acid despite normal renal function. In this report, we review the literature exploring nephrotoxicity secondary to Zoledronic acid use, recognizing that there are other reported cases of Fanconi syndrome; however, all in patients with malignancy rather than for osteoporosis. We also present one of the first cases of Fanconi syndrome after just a single exposure to Zoledronic acid in a patient who had normal preceding renal function. This highlights the need to be aware of the possibility of significant nephrotoxicity after a single exposure to Zoledronic acid even without the recognized risk factors of chronic or acute kidney disease.