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Bisphosphonate Acute Phase Reaction — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseBisphosphonate Acute Phase ReactionSCE Rheumatology

A 55-year-old woman on long-term IV Zoledronate for osteoporosis (annual infusion for 3 years) develops flu-like symptoms with fever myalgia and arthralgia 24 hours after her fourth infusion. What is the most likely explanation?

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Correct answer: A — Acute phase reaction to IV bisphosphonate

Acute phase reactions (flu-like symptoms with fever myalgia arthralgia and headache) are common after IV bisphosphonate infusions particularly Zoledronate. They typically occur within 24-72 hours of infusion and are most common after the first dose (up to 30% of patients) becoming less frequent with subsequent doses. The reaction is self-limiting and managed with Paracetamol and NSAIDs. Pre-treatment with Paracetamol may reduce severity. It does not represent allergy and is not a contraindication to future infusions.

Reference: NOGG 2021; BNF Zoledronic acid monograph