My dad has been receiveing zoledronic acid for past 2 months after a rise in his psa.(on abiraterone for past 1 year and psa started rising this june.doc has advised to continue taking abiraterone and has prescribed zoledronic infusions).
After starting zoledronic his ALP has seen a mild reduction and is within normal limits but creatinine has risen drom .79 to 1.05.Also eGFR has decreased from 94 to 74 after 2 infusions.
Should he continue with monthly zoledronic injections?
He is taking medicines for diabetes(alsp insulin), high blood pressure and thyroid problems.
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Vsahay
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There is a FDA warning about possible kidney damage with Zaledronic acid in some patients.
A serum creatinine of 1.05 is not clear indication of kidney damage as it is still within normal range. Upper limit of normal creatinine is 1.17
eGFR is considered OK as long as it stays above 60. Minor kidney related parameter changes are not uncommon. A close eye on creatinine and BUN should be kept.
Review his other medicines and see if there is any other med he is taking which can cause kidney injury. Discuss with his doctor. This is not a medical advice.
Two most important indicators of kidney function are (1) Blood Urea Nitrogen and (2) creatinine. If both of these are in normal limits, it means kidneys are doing fine.
When kidney damage starts happening, these two numbers start going up above the stated normal range..
I will first check my bone density by DEXA scan and if my T score comes normal , I will not agree to zoledronic acid or denosumab. I keep checking my bone mineral density every 3 months and chart it to see any significant decline in T values. I am not on any bone meds and plan to stay this way until my T score goes below -2.0 (presently it is -1.0)
Don’t pay too much attention to the normal limits. Serum creatinine level is the result of production from muscle and excretion from the kidney. Muscular people typically have higher creatinines. Assuming the amount of muscle stays constant the serum creatinine should reflect kidney function and a 10% increase in creatinine as your Dad had is just that. I would follow it and see it returns to his baseline over a couple of months. At this point he has plenty of kidney function but if it happens every infusion it could be a problem.
Totally agree with TA on this. Why someone need to be on zoledronic acid if his Bone Density Scan (called as DEXA) shows normal bone density ? There is no reason for bone medication...if his T score on Bone Density Scans are showing normal values. In such a case, some dietary calcium in form of home made yogurt and vit D 800 mg a day, green leafy vegetables , with regular walking 3 to 5 miles a day and Yoga stretching poses will be more than sufficient to preserve bones.
With any drug, one has to look at the therapeutic ratio (benefits vs harms). You are right that the STAMPEDE trial, where this salubrious combination was discovered, mainly looked at newly diagnosed men with metastases. But with men living longer, and the risks of side effects of bone strengthening agents increasing with time taking the drugs, I think there is a balance to be considered.
Here's the prescribing information for Zometa which includes dose reduction for creatinine. It looks like it would need to be out of range in order to require dose reduction. You can find a table for creatine level vs. dose in the prescribing information linked below:
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