Reclast (zoledronic acid 5 mg) injection has been approved by the US Food and Drug Administration (FDA) as the first and only therapy to prevent postmenopausal osteoporosis for two years with a single dose. Reclast, or Aclasta as it is known outside the US, is already approved in more than 80 countries including the US and EU as a once-yearly infusion for the treatment of postmenopausal osteoporosis.

The FDA decision is based on a study involving more than 500 postmenopausal women with osteopenia, or low bone mass, showing that a single infusion of Reclast significantly increased bone mineral density (BMD) at two years compared to placebo.

Approximately 22 million women in the US have osteopenia, putting them at increased risk of osteoporosis, a disease that causes bones to break more easily. Osteoporosis is a major public health threat affecting an estimated 10 million men and women in the US.

Although low bone mass is less severe in people with osteopenia than those with osteoporosis, they are still at increased risk of fractures. In fact, research shows that approximately half of women who experience a fragility fracture, or a broken bone due to a fall from standing height or less, have osteopenia, highlighting the importance of treating and preventing further bone loss.

"It is very important to treat postmenopausal women with low bone mass to prevent them from progressing to osteoporosis," said Mone Zaidi, professor of Medicine, Geriatrics, and Physiology and Director of The Mount Sinai Bone Program at Mount Sinai School of Medicine in New York, USA. "The dosing of Reclast for the prevention of postmenopausal osteoporosis offers an advance over existing therapies since it can be given once every two years, instead of daily, weekly or monthly."

Reclast is already approved in the US as a once-yearly infusion to treat postmenopausal osteoporosis, to increase bone mass in men with osteoporosis, and to treat and prevent osteoporosis caused by glucocorticoids, commonly know as steroids. In the EU, Aclasta is approved for the treatment of osteoporosis in postmenopausal women and in men at increased risk of fracture, including those with a low trauma hip fracture. Additionally, the Committee for Medicinal Products for Human Use (CHMP) has issued a positive opinion recommending Aclasta for the treatment of glucocorticoid-induced osteoporosis in the EU. Aclasta/Reclast is also approved in the US and EU for the treatment of Paget's disease of bone, the second most common metabolic bone disorder, in men and women.

"We are very pleased with this latest US approval that recognizes the large body of safety and efficacy data for Aclasta/Reclast and underlines its potential to protect patients with a number of bone disorders," said Trevor Mundel, global head of Development at Novartis Pharma AG. "Women with low bone mass in the US now have an important new option that is proven to strengthen their bones, and therefore prevent the onset of osteoporosis, for a full two years with only one infusion."

The new US indication to prevent bone loss in postmenopausal women with osteopenia was based on a two-year randomized, multi-center, double-blind, placebo-controlled study of 581 postmenopausal women older than 45 years of age. The primary endpoint was the change in BMD at two years relative to baseline.

This study included women in early menopause (i.e. within five years of menopause) and late menopause (i.e. more than five years from menopause). Patients were divided into three groups and received either Reclast at the beginning of the study and again at one year, Reclast at the beginning of the study and placebo at one year, or placebo at the beginning of the study and placebo again at one year.

Reclast significantly increased lumbar spine BMD relative to placebo at the end of the two-year study. Treatment with Reclast given as a single dose at the beginning of the study increased lumbar spine BMD by 6.3 per cent in the early menopause group and by 5.4% in the late menopause group at two years (both p<0.0001).

Aclasta/Reclast is generally safe and well tolerated. The most common adverse events associated with Aclasta/Reclast are transient post-dose symptoms such as fever and muscle pain. Most of these symptoms occur within the first three days following Aclasta/Reclast administration and resolve within three days. The incidence of such post-dose symptoms can be reduced with the administration of paracetamol or ibuprofen shortly after Aclasta/Reclast infusion.

Aclasta/Reclast has been used in nearly 500,000 patients worldwide, including more than 238,000 in the US, to help prevent fractures. It is available in all 50 US states and reimbursed by all Medicare Part B carriers and virtually all health insurance plans. Reclast can be administered in physicians' offices or at one of the more than 5,600 infusion centers located throughout the US.

Zoledronic acid, the active ingredient in Aclasta/Reclast, is also available under the trade-name Zometa for use in oncology indications.