title: Acute phase response following intravenous zoledronate in postmenopausal women with low bone mass.
abstract: An acute phase response (APR) is frequently observed in patients treated with intravenous (i.v.) zoledronate (ZOL). We aimed to define clinical and laboratory parameters that may predict ZOL-induced APR in women with low bone mass. Fifty-one postmenopausal women with low bone mass were given a single i.v. infusion of ZOL 5mg. APR was clinically defined by the visual analog pain scale (VAS) for the musculoskeletal symptoms and body temperature. White blood cell count (WBC), leucocyte subpopulations, C-reactive protein (CRP), parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], interleukins (IL)-1b and -6, tumor necrosis factor (TNF)α and interferon (IFN)γ were measured before and 48 h following the infusion. Subsequently, patients were divided into those experiencing APR (APR+) or not (APR-). WBC, granulocytes, CRP, IL-1b and IL-6 were significantly increased, whereas lymphocytes, eosinophils, calcium, phosphate and 25(OH)D decreased 48h after ZOL infusion. Twenty-eight of the 51 patients (54.9%) experienced an APR. APR+ patients were younger and had higher baseline lymphocytes compared to APR- patients. There was no difference (p=0.405) in the development of APR between treatment-naive patients (19/32, 59.4%) and patients previously treated with another oral nitrogen-containing bisphosphonate (9/19, 47.4%). In conclusion, our data suggest that pre-treatment higher lymphocyte number increases the risk of APR while previous treatment with another nitrogen-containing bisphosphonate does not significantly reduce the risk. Serum 25(OH)D concentrations decrease significantly after the infusion, possibly as part of the inflammatory response to ZOL.
authors.affiliation: Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece. anastath@endo.gr
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Anastasilakis
authors.forename: Stergios A
authors.initials: SA
authors.lastname: Polyzos
authors.forename: Polyzois
authors.initials: P
authors.lastname: Makras
authors.forename: Grigorios T
authors.initials: GT
authors.lastname: Sakellariou
authors.forename: Ilias
authors.initials: I
authors.lastname: Bisbinas
authors.forename: Athina
authors.initials: A
authors.lastname: Gkiomisi
authors.forename: Sideris
authors.initials: S
authors.lastname: Delaroudis
authors.forename: Spyridon
authors.initials: S
authors.lastname: Gerou
authors.forename: Iris
authors.initials: I
authors.lastname: Ballaouri
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Oikonomou
authors.forename: Socrates E
authors.initials: SE
authors.lastname: Papapoulos
mesh_terms: D000210:Acute-Phase Reaction / Q000139:chemically induced* / Q000473:pathology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology*; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D007275:Injections, Intravenous; D016015:Logistic Models; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D017698:Postmenopause / Q000187:drug effects*; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid