Metabolic bone disease: zoledronic acid acute-phase reaction: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Metabolic bone disease: zoledronic acid acute-phase reaction

Sample item

A woman has fever, myalgia and bone pain the day after her first intravenous infusion of zoledronic acid for osteoporosis. What is the best explanation and management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Acute-phase reaction, treated with paracetamol

An acute-phase reaction with flu-like symptoms occurs in up to a third of patients after the first dose of an intravenous nitrogen-containing bisphosphonate. It settles in a few days and is controlled with paracetamol, and it is much less frequent with later infusions.

Option by option

  • A. Bacterial sepsis, treated with broad-spectrum antibiotics

    Sepsis is not suggested by symptoms that start within a day of an infusion and are limited to flu-like features.

  • B. Hypocalcaemic tetany, treated with intravenous calcium

    Hypocalcaemia causes perioral tingling and spasm, not fever and myalgia.

  • C. Drug allergy, treated by permanent withdrawal of all antiresorptives

    True allergy is uncommon and the reaction here does not require stopping all antiresorptive therapy.

  • D. Acute-phase reaction, treated with paracetamol (correct)

    Correct. A self-limiting flu-like reaction after the first infusion is an acute-phase reaction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Acute-phase reaction, treated with paracetamol. An acute-phase reaction with flu-like symptoms occurs in up to a third of patients after the first dose of an intravenous nitrogen-containing bisphosphonate.

Why is "Bacterial sepsis, treated with broad-spectrum antibiotics" not the answer?

Sepsis is not suggested by symptoms that start within a day of an infusion and are limited to flu-like features.

Why is "Hypocalcaemic tetany, treated with intravenous calcium" not the answer?

Hypocalcaemia causes perioral tingling and spasm, not fever and myalgia.

Why is "Drug allergy, treated by permanent withdrawal of all antiresorptives" not the answer?

True allergy is uncommon and the reaction here does not require stopping all antiresorptive therapy.

What concept does this question test?

It tests Metabolic bone disease: zoledronic acid acute-phase reaction in Orthopaedics. It settles in a few days and is controlled with paracetamol, and it is much less frequent with later infusions.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Metabolic bone disease: zoledronic acid acute-phase reaction?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.