Intravenous Zoledronic Acid for Bone Pain Relief in Cancer Patients with Bone Metastasis Receiving Low Dose Opioids and Nsaids: A Randomized Controlled Study.

Bone is a frequent site of metastasis, particularly in breast, lung, prostate, and renal cancers. Skeletal metastases lead to severe pain, fractures, hypercalcemia, and reduced quality of life. Zoledronic acid(ZA), a potent intravenous bisphosphonate, inhibits osteoclast-mediated bone resorption and may reduce metastatic bone pain. This study assessed the efficacy and safety of intravenous zoledronic acid in relieving bone pain in patients with bone metastases receiving standard analgesics. In this randomized prospective controlled study, out of 120, 70 adults aged 30-70 years with confirmed bone metastases and visual analog score of >4 who completed the follow up were enrolled. Patients were randomized into two groups (35 each), Group Z received ZA 4 mg intravenously (every 4 wk) along with low-dose morphine 5 mg every 4 h and tablet etoricoxib 60 mg twice daily and Group P received tab morphine 5 mg every 4 h and tab etoricoxib 60 mg twice daily. All patients received calcium and vitamin D supplementation. Weekly assessments included BPI scores, skeletal-related events, and adverse effects. Patients receiving intravenous ZA demonstrated significantly greater reductions in pain severity and fewer skeletal-related events than Group P (p < 0.05). No serious drug-related adverse effects were noted.