Zoledronic acid

Key points about zoledronic acid

  • Zoledronic acid is also called zoledronate, Aclasta® or Zometa®.
  • It is used to treat bone disease such as osteoporosis and Paget's disease.
  • Find out how to have it safely and possible side effects.
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  • Zoledronate used to treat bone disease such as osteoporosis and Paget's disease. 
    • Osteoporosis is a condition that causes your bones to be thinner and weaker than normal. This means that they can break (fracture) easily, such as after a small bump or fall. In osteoporosis zoledronate prevent bone loss, increase bone thickness and lower your risk of spine and hip fractures. For the treatment of osteoporosis, zoledronate injection is used if the tablet forms of bisphosphonates are unsuitable for you.  
    • In Paget's disease the abnormal bone growth causes deformity and pain. Zoledronate can help with this.
  • Zoledronate may also be used to reduce the high levels of calcium in the blood (called hypercalcaemia) which can happen with some cancers.
  • Zoledronate is given by injection, as a drip into the vein. It belongs to a group of medicines called bisphosphonates.

Watch a video about zoledronate for the treatment of osteoporosis:

(RheumInfo, 2019)

  • Zoledronate is given by intravenous infusion or 'drip', so medication is injected into the vein in the arm and drips in slowly over 15 to 30 minutes.  
  • The number of doses you will be given will depend upon why it has been prescribed for you. Many people need only a single dose. Extra doses may be needed for people with osteoporosis and in some cancers.
  • Zoledronate infusion can be given to you by your GP or you may be referred to a specialist or clinic.

Special instructions

  • Blood tests: before having zoledronate infusion, you will need blood tests to check the calcium levels in your blood and how well your kidneys are working. 
  • Avoid dehydration: it is important that you do not become dehydrated during treatment with zoledronate. Your doctor will advise how much water you need to drink – this is usually one or two large glassfuls before and after treatment.
  • Calcium and vitamin D: for zoledronate to work, you may need to take vitamin D (also called colecalciferol) supplements and ensure that you have enough calcium in your diet.

Like all medicines zoledronate can cause side effects, although not everyone gets them.

Problems with your jaw

Zoledronate can cause osteonecrosis of the jaw, which is a problem with the jaw, that can be caused by delayed healing in the mouth after some dental procedures. This is quite rare. To reduce the risk of this problem, it is best to:

  • Take good care of your teeth and mouth (such as brushing your teeth twice a day and regular flossing between your teeth).
  • Have regular dental check-ups.
  • If you need any dental treatment, it is best that you have this done before you start treatment with zoledronate.
  • Let your dentist know that you are having zoledronate treatment.
  • Talk to your doctor or dentist if you have any loose teeth, tooth pain, or swelling or numbness in your jaw.

Other side effects

Side effects What to do
  • Flu-like symptoms such as muscle and joint pains, fever, headache
  • Irritation or burning at the site of the injection 
  • These symptoms are quite common with zoledronate injection. They tend to go away after a few days.
  • Your doctor can recommend a mild pain reliever such as paracetamol to reduce these side effects. 
  • Tell your doctor if troublesome
  • Eye pain
  • Red eye
  • Changes in your vision
  • Sensitive to light
  • Floating spots in your vision
  • These symptoms are related to inflammation in the eye. This is quite rare.³
  • Contact your doctor immediately if you experience these symptoms. 
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)

The following links provide further information on zoledronate. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Zoledronate(external link) Rheuminfo
Zoledronic acid (for cancer patients)(external link)
New Zealand Formulary Patient Information
Zoledronic acid (for osteoporosis)(external link) New Zealand Formulary Patient Information
Aclasta(external link) Medsafe Consumer Information (NZ)
Zometa(external link) Medsafe Consumer Information (NZ)

Zoledronic acid (Aclasta)(external link) National Osteoporosis Society, UK
Drug treatments for osteoporosis(external link) Royal Osteoporosis Society, UK, 2023


5 questions to ask about your medications(external link) Health Quality and Safety Commission, NZ, 2019 English(external link), te reo Māori(external link)


  1. Osteonecrosis: A Pain in the Jaw(external link) Medsafe Prescriber Update 33(2): 13-14 June 2012
  2. Osteonecrosis Of The Jaw And Bisphosphonates - Putting The Risk In Perspective(external link) Medsafe Publications, October 2007
  3. Reminder: Keeping an eye on bisphosphonates(external link) Medsafe Prescriber Update 32(3): 24 September 2011
  4. An update on bisphosphonates(external link) BPAC, November 2014
  5. Zoledronic acid(external link) New Zealand Formulary 
  6. Zometa(external link) Medsafe Datasheet
  7. Aclasta(external link) Medsafe Datasheet


Drug treatments for osteoporosis
Royal Osteoporosis Society, UK, 2023

5 questions to ask about your medications

5 questions to ask about your medications

Health Quality and Safety Commission, NZ, 2019

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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