Zoledronate Induced Hypocalcemia and Hypophosphatemia in Osteoporosis: A Cause of Concern

Zoledronate is a Nitrogen containing bisphosphonate (NBP) used in many conditions like osteoporosis, Paget’s disease and hypercalcemia of malignancy. Unlike oral bisphosphonates, Zoledronate is not seen to be associated with gastroesophageal side effects but the drug is not free of certain rare but life threatening adverse effects like hypocalcemia and renal deterioration. Majority of cases of hypocalcemia with Zoledronate are seen in patients with underlying malignancy and are asymptomatic. Here we present a case of severe symptomatic hypocalcemia along with hypophosphatemia following zoledronate administration in an elderly male with a history of osteoporotic fracture.