Skip to main content

Zoledronic acid

Aclasta, Zerlinda, Zometa

Zoledronic acid is given by intravenous infusion in a hospital setting.

You will be asked to drink several glasses of water during treatment to make sure that you are not dehydrated.

Your doctor may recommend that you see your dentist before receiving this treatment.

At a glance

  • Zoledronic acid is a medicine used to treat osteoporosis, Paget's disease of bone, and bone problems related to some cancers.

  • It helps strengthen bones and can reduce high calcium levels in the blood for cancer patients.

  • Zoledronic acid is given as a slow injection into a vein in a hospital clinic.

  • You should drink plenty of water and maintain good dental hygiene during treatment.

  • See your doctor if you experience pain in your thigh, hip, groin, jaw, or a loose tooth.

Continue reading below

About zoledronic acid

Type of medicine

Bisphosphonate

Used for

Osteoporosis; Paget's disease of bone; bone problems associated with some cancers

Also called

Aclasta®; Zerlinda®; Zometa®

Available as

Injection

Zoledronic acid, a bisphosphonate, is prescribed for the treatment of a number of different problems which affect bones. It is prescribed as a treatment for osteoporosis, and it is also used to prevent bone damage in people with Paget's disease of bone. It is also given as a treatment for people with some cancers in order to reduce bone damage and blood calcium levels.

Osteoporosis is a bone disease which causes bones to become brittle and fragile, making them prone to breaks and fractures. During our lifetime, old bone tissue is constantly being broken down and replaced by new bone. As we get older, our bone begins to lose density because old bone is lost faster than new bone can replace it. Zoledronic acid slows down the rate at which old bone is lost and this leads to an overall increase in bone density.

In Paget's disease of bone, zoledronic acid works on bones to make them stronger and help prevent bone thickening. This helps ease symptoms such as pain, bone damage and fracture.

In some cancers there can be an excessive breakdown of bone. As this happens, calcium is lost from the bone and seeps into the blood, leading to higher than normal levels of calcium in the blood. This is called hypercalcaemia. Zoledronic acid binds to bone and reduces the rate at which it is broken down. This helps to strengthen bones and prevents the loss of calcium. This in turn reduces the high levels of calcium in the blood.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start treatment it is important that your doctor knows:

  • If you are pregnant or breastfeeding. Zoledronic acid is not suitable for women who could become pregnant.

  • If you are due to have any dental treatment in the near future, or if you have not recently had a dental check-up.

  • If you have a heart condition.

  • If you have any problems with the way your kidneys work, or with the way your liver works.

  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

  • If you have ever had an allergic reaction to a medicine.

Continue reading below

  • Before you start the treatment, ask to read the manufacturer's printed information leaflet from inside the pack. It will give you more information about zoledronic acid and will provide you with a full list of the side-effects which you may experience from having it.

  • Zoledronic acid will be given to you in a hospital clinic. It will be administered by intravenous infusion - this means that it is injected slowly (over 15 minutes or so) into one of your veins.

  • The number of doses you will be given will depend upon the reason why it has been prescribed for you. Many people require only a single dose, although repeat doses can be required for people with osteoporosis and in some cancers.

  • It is important that you do not become dehydrated during treatment with zoledronic acid. Your doctor will advise how much water you need to drink - this is usually one or two large glassfuls before and after treatment.

  • If you have osteoporosis or Paget's disease of bone, it may be necessary for you to take supplements of calcium and vitamin D alongside this treatment. If so, your doctor will prescribe these for you.

  • Good dental hygiene is important during treatment with this medicine - this means that you must brush your teeth regularly and have regular dental check-ups. You should also make sure that your dentist is aware that you have had zoledronic acid, as some dental treatments may not be recommended for you.

  • Remember to keep your regular appointments with your doctor so that your progress can be monitored. You may need to have blood tests following this treatment.

  • You should avoid becoming pregnant whilst you are being treated with zoledronic acid. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.

Continue reading below

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with zoledronic acid. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common side-effects (these affect fewer than 1 in 10 people)


What can I do if I experience this?

Conjunctivitis, feeling dizzy

Take care, especially if using tools or machines

Feeling sick (nausea) or being sick (vomiting), gastrointestinal upset

Stick to simple foods and drink plenty of water to replace any lost fluids

Headache, high temperature (fever), aches and pains, flu-like symptoms

Ask your doctor or pharmacist to recommend a suitable painkiller, and take plenty of rest and fluids

Changes in heart rhythm and changes to some blood test results

Your doctor will monitor for these

Swelling or pain at the infusion site

This should soon pass

Less common, but possibly serious, side-effects

What should I do if I experience this?

Pain in your thigh, hip, or groin

Speak with your doctor as soon as possible - these can be signs of a thighbone fracture

A loose tooth, or jaw pain with swelling or numbness

Speak with your doctor as soon as possible - these can be signs of a problem called osteonecrosis of the jaw

Ear pain, discharge from an ear, ear infection

These could be signs of a problem called osteonecrosis of the ear. Speak with your doctor straightaway

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

Important information about all medicines

If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

Always read the printed information leaflet that comes with your medicine.

If you have any questions about this medicine ask your pharmacist.

Report side effects to a medicine or vaccine

If you experience side effects, you can report them online through the Yellow Card website.

symptom checker

Unsure about mixing medicines?

Check for possible interactions between medicines, supplements and foods before taking them together.

Frequently asked questions

How does zoledronic acid actually work to strengthen bones?

Zoledronic acid is a bisphosphonate medicine. In conditions like osteoporosis, it works by slowing down the rate at which old bone tissue is broken down. This allows new bone tissue to form, leading to an overall increase in bone density. For Paget's disease, it works to make bones stronger and prevent them from thickening, which helps reduce symptoms like pain and bone damage. In certain cancers, it also reduces bone breakdown, which prevents calcium from excessively entering the blood and strengthens the bones.

What's the difference between how zoledronic acid is used for osteoporosis versus cancer?

Zoledronic acid helps with both conditions by strengthening bones. For osteoporosis, it increases overall bone density by slowing down the loss of old bone. For some cancers, its main role is to reduce bone damage and prevent high calcium levels in the blood (hypercalcaemia) that can occur when bone breaks down excessively due to the cancer.

How often will I need to have zoledronic acid injections?

The frequency of your zoledronic acid injections depends on why you are being treated. Many patients only need a single dose. However, if you have osteoporosis or certain types of cancer, you may require repeat doses to manage your condition effectively.

Are there any specific drinks or foods I should avoid while on zoledronic acid?

The article doesn't mention specific foods to avoid. However, it is very important to stay well-hydrated during your treatment with zoledronic acid. Your doctor will tell you how much water to drink, which is typically one or two large glasses before and after your infusion.

What should I do if I notice a new pain in my hip or jaw after treatment?

If you experience pain in your thigh, hip, or groin, or jaw pain accompanied by swelling or numbness, you should speak with your doctor as soon as possible. These symptoms could be signs of serious side-effects like a thighbone fracture or osteonecrosis of the jaw, which require prompt medical attention.

What should I do if I forget to drink enough water around my treatment time?

It is important not to become dehydrated during your treatment with zoledronic acid. While the article emphasizes drinking one to two large glassfuls of water before and after treatment, it doesn't specify what to do if you accidentally miss this. You should contact your doctor or the hospital clinic for advice if you are concerned about your hydration around your treatment.

Can I continue to take my usual vitamins and supplements when having zoledronic acid?

You should tell your doctor about all medicines you are taking, including any available without a prescription, as well as herbal and complementary medicines, before starting treatment with zoledronic acid. If you have osteoporosis or Paget's disease of bone, your doctor may specifically prescribe calcium and vitamin D supplements to be taken alongside this treatment.

Further reading and references

Continue reading below

About the authorView full bio

Author image

Michael Stewart, MRPharmS

Medicine Leaflet Review Manager – Contractor, Pharmacist

BPharm (Hons), MRPharmS

Michael is a community pharmacist practicing in the Midlands and South Yorkshire with more than 20 years’ experience advising on medicines and medical conditions. He has a strong background in healthcare training, having produced and delivered training courses for pharmacy teams and staff of residential care settings, including nurses. He has also contributed to pharmacy advisory boards for the management of low acuity conditions in the community.

About the reviewer

Author image

Sid Dajani

Sultan Dajani qualified at the London School of Pharmacy in 1994 and became the youngest elected member of the Royal Pharmaceutical Society council since its founding in 1842.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

flu eligibility checker

Ask, share, connect.

Browse discussions, ask questions, and share experiences across hundreds of health topics.

Sign up to the Patient newsletter

Your weekly dose of clear, trustworthy health advice - written to help you feel informed, confident and in control.

Please enter a valid email address

By subscribing you accept our Privacy Policy. You can unsubscribe at any time. We never sell your data.