Tania Winzenberg, MBBS, FRACGP, MMedSc, PhD Graeme Jones, MBBS, FRACP, MD Menzies Research Institute, Hobart, Tasmania, Australia tania.winzenberg@utas.edu.au
Dr. Winzenberg reported no potential conflict of interest relevant to this article. Dr. Jones reported that he receives research support from Merck Sharp & Dohme and Servier; serves as a consultant to Amgen, Merck Sharp & Dohme, and Servier; and is on the speakers bureau of Amgen, Lilly, Merck Sharp & Dohme, and sanofi-aventis.
An inability to stay upright for 30 minutes after drug administration is a contraindication to the use of oral bisphosphonates. The presence of upper GI symptoms is also a concern. You offer Mrs. Y the option of a once-yearly IV infusion of zoledronic acid instead, and she and her husband agree to this. Before scheduling a follow-up visit, you discuss the patient’s nutritional intake, and discover that she consumes only a moderate amount of calcium—at most 2 servings of dairy products per day. You also note that her serum vitamin D level was not checked in the hospital. You order lab work, with a view to correcting any deficiency before proceeding with a zoledronic infusion (due to the risk of tetany) and to maintaining her on an appropriate level of calcium and vitamin D intake, using supplements only if necessary.
CORRESPONDENCE Tania Winzenberg, MBBS, Menzies Research Institute, Private Bag 23, Hobart, Tasmania, Australia 7001; tania.winzenberg@utas.edu.au
