Zoledronic acid infusion for osteoporosis is not recommended for patients with a glomerular filtration rate ≤ 35 mL/min. During the period 2012–2019, 96.8% of patients had renal function testing with a creatinine level and estimated glomerular filtration rate within 365 days prior to infusion. A chart survey of 20 patients who did not have an estimated glomerular filtration rate in the electronic medical record revealed that all 20 had labs done outside Cleveland Clinic, which were documented in the chart prior to zoledronic acid infusion.
Zoledronic acid infusion for osteoporosis may be associated with hypocalcemia after infusion. Patients with hypovitaminosis D are at higher risk for hypocalcemia. Obtaining a vitamin D level is considered standard of care for patients prior to infusion. 74.4%, 84.1%, and 90.4% of patients undergoing infusion had a vitamin D level measured in the preceding 90, 180, and 365 days, respectively before infusion.