Does Zoledronic Acid Improve Appendicular Lean Mass in Older Women with Osteoporosis? A Sub-Analysis of a Randomized Clinical Trial

Background Coexistence of osteoporosis and sarcopenia (osteosarcopenia), is associated with increased risk for fractures, falls, and mortality. Although there are multiple medications for management of osteoporosis, there are no approved pharmacotherapy for sarcopenia. Objectives We examined the effect of zoledronic acid on muscle mass indices including ALM (Appendicular Lean Mass) and ALM/Height 2 in a cohort of older women with osteoporosis who were residents of Long-Term Care Communities (LTCCs). Design A secondary analysis of a 2-year double-blind, randomized, placebo-controlled clinical trial. Setting Residents of LTCCs. Participants Sixty-two postmenopausal women with osteoporosis. Intervention Participants either received 5 mg infusion of zoledronic acid or placebo, once at the start of the study. Measurements Participant’s ALM/Height 2 , ALM, total hip BMD (Bone Mineral Density) and spine BMD were measured in 6, 12 and 24 months. Results On average, participants were 86.7 years old and had a BMI of 27.4 kg/m 2 . There was no significant difference in change from baseline (mean ± SE) between the treatment group and the placebo group in ALM/Height 2 : (−0.15 vs −0.02, p = 0.541) and (−0.17 vs 0.001, p = 0.315) and (−0.29 vs −0.19, p = 0.646) or ALM: (−0.38 vs −0.09, p = 0.455) and (−0.45 vs −0.005, p = 0.216) and (−0.70 vs −0.48, p = 0.553) at 6, 12, and 24 months respectively. In addition, after adjusting for a possible confounding, the ALM/Height 2 or ALM did not have significant improvements from baseline at 6 months, 12 months, and 24 months either in the treatment group or in the placebo group. However, there were significant improvements in the BMD at the total hip and the spine in the treatment group compared with the placebo group at all three time points. Conclusions Among older women residing in LTCCs, a single dose of zoledronic acid did not increase ALM/Height 2 and ALM, despite improving the BMD at the total hip and the spine at the 2-year follow-up.