TOPLINE:

A single 5-mg infusion of zoledronic acid administered before bariatric surgery did not prevent loss of muscle mass or strength nor did it improve physical function 12 months after surgery compared with placebo.

METHODOLOGY:

• Researchers conducted a secondary analysis of a clinical trial to assess whether prophylactic zoledronic acid administered before bariatric surgery could preserve muscle mass, strength, and physical function.
• Participants were randomly assigned to receive either a single 5-mg intravenous dose of zoledronic acid 7-59 days before surgery or placebo.
• Body composition was assessed by dual-energy X-ray absorptiometry, lower- and upper-extremity muscle strength were measured by dynamometer, and physical function was evaluated using standardized tests.
• Self-reported physical activity was captured using the International Physical Activity Questionnaire-Short Form.

TAKEAWAY:

• Of 59 patients, 31 received zoledronic acid (mean age, 48.5 years; 19 female; mean BMI, 41.8) and 28 received placebo (mean age, 49.3 years; 24 female; mean BMI, 42.8).
• At 12 months, reductions in body weight, fat mass, lean body mass, and appendicular lean mass did not differ significantly between groups. Both groups lost approximately 14% of lean body mass.
• No significant between-group differences were observed in lower- or upper- extremity muscle strength or handgrip strength, except for some isolated findings. Both groups had similar absolute declines in knee extensor and flexor strength (10.7%-15.4%), whereas relative strength improved by 10.0%-22.0% across contraction modalities.
• Habitual and maximal walking speed, endurance capacity, lower-limb muscle power, and self-reported physical activity also did not differ significantly between groups.
• By surgery type, Roux-en-Y gastric bypass produced significantly greater fat mass loss than sleeve gastrectomy and was associated with smaller declines in isokinetic muscle strength.

IN PRACTICE:

“In our study, zoledronic acid prevented bone loss but did not attenuate lean mass reduction. This suggests that targeting bone resorption alone is insufficient to preserve skeletal muscle in humans, despite promising preclinical findings,” the authors wrote. 

SOURCE:

The study was led by Søren Gam, Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark, and was published online in Obesity.

LIMITATIONS:

This secondary analysis may have been underpowered to detect subtle between-group differences. A single preoperative dose of zoledronic acid may not have been optimal in timing or dosage to affect muscle preservation. Key cytokines, including transforming growth factor‑beta and receptor activator of nuclear factor kappa‑B ligand, were not measured. Findings were limited to patients undergoing bariatric surgery, possibly limiting the generalizability.

DISCLOSURES:

The study was funded by the University of Southern Denmark, Steno Diabetes Center Odense, Odense University Hospital, and other sources. Some authors reported receiving institutional grants, travel support, or honoraria for lectures and educational events from; serving on advisory panels for; or having other ties with various organizations and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.