Amazing how a slight change in google terms brings up totally new issues to consider. I was not aware of the level of danger from hypercalcemia..especially in those
without bone mets. This may not specifically apply to your situation..but it suggests there are some differences in how they work:
Oncologist. 2002;7(6):481-91.
The use of zoledronic acid, a novel, highly potent bisphosphonate, for the treatment of hypercalcemia of malignancy.
Major P.
Department of Medicine, McMaster University, 699 Concession Street, Hamilton, Ontario, Canada L8V 5C2.
Pierre.major@hrcc.on.ca
FREE TEXT
Abstract
BACKGROUND:
Hypercalcemia of malignancy is a serious complication of cancer that affects patients with and without bone metastases. A single infusion of pamidronate disodium, a nitrogen-containing bisphosphonate, effectively normalizes serum calcium in the majority of patients treated for up to 1 month. Zoledronic acid is a new-generation, heterocyclic nitrogen-containing bisphosphonate and the most potent inhibitor of bone resorption identified to date.
METHODS: The natural history, clinical presentation, and treatment of hypercalcemia of malignancy are reviewed, with a focus on the mechanisms of action and relative efficacy and safety of bisphosphonate therapies.
RESULTS: The improved efficacy of zoledronic acid compared with pamidronate disodium has been demonstrated in a pooled analysis of two randomized clinical trials in patients with hypercalcemia of malignancy. In these trials,
both zoledronic acid and pamidronate disodium were safe and well tolerated; however, zoledronic acid treatment resulted in a significantly higher number of complete responses, more rapid calcium normalization, and more durable responses compared with pamidronate disodium.
CONCLUSIONS: Given the superior efficacy and comparable safety profile of zoledronic acid compared with pamidronate disodium, zoledronic acid is likely to become the treatment of choice for hypercalcemia of malignancy.
PMID: 12490736 [PubMed - indexed for MEDLINE]Free Article
More on Zoledronic acid/Zometa
HERE
From an earlier comparison of Zometa vs Pam, a bit on hypercalcemia:
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Quote:
INTRODUCTION
HYPERCALCEMIA OF malignancy (HCM) is the most common life-threatening metabolic complication of malignancy, affecting approximately 10% to 20% of patients with advanced cancer.1 The incidence of HCM varies widely by cancer type but occurs most frequently in patients with multiple myeloma and carcinomas of the lung, breast, kidney, and head and neck.2-4 A retrospective study of cancer-associated hypercalcemia reported that median survival was 30 days in patients treated with antihypercalcemic therapy.5 Clinical symptoms of HCM such as nausea, vomiting, and altered mental status are distressing and diminish quality of life in the later stages of cancer progression. HCM can also lead to renal failure.
Patients with or without bone metastases can develop HCM. Hypercalcemia is mediated by soluble factors secreted by tumor cells and the immune system, such as parathyroid hormone–related protein (PTHrP), prostaglandins, and cytokines. These factors stimulate excess bone resorption and release of calcium from the bone matrix. As a result, patients experience bone loss, weakened bone structure, and elevated circulating calcium levels.1,6-8 PTHrP also stimulates increased renal reabsorption of calcium, resulting in further increases in serum calcium levels.
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