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Case Reports: Adverse drug reactions and complications
Proinflammatory reaction to a bisphosphonate infusion in a patient with a reverse shoulder replacement and literature review
  1. Rebecca Miles1,
  2. Austin McCadden2 and
  3. Kyong Min1,2
  1. 1F Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  2. 2Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA
  1. Correspondence to Dr Kyong Min; kyongminmd{at}gmail.com

Abstract

Bisphosphonates are the first-line pharmacological treatment for osteoporosis due to their efficacy and low rate of self-limited adverse effects. Challenges in adherence to oral treatment has spurred the development of third-generation bisphosphonates that only require single annual infusion due to high potency and binding efficacy. The authors report the case of a woman in her 70s who presented with postoperative shoulder pain after zoledronic acid infusion. Diagnostic work-up revealed stable prosthesis with no signs of fracture, loosening or infection. Administration of oral steroids resulted in resolution of pain and return to baseline function. Acute postoperative joint pain attributed to bisphosphonate infusion has not been previously described in the literature. This case report and literature review suggests consideration of adverse inflammatory reaction due to bisphosphonate infusion in the setting of a patient presenting with joint replacement and acute exacerbation of pain without clear aetiology.

  • Musculoskeletal and joint disorders
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2022-251524

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    Footnotes

    • Contributors RM performed literature review, manuscript writing and editing. MC performed manuscript editing. RM developed the study idea and performed manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.