March 07, 2018
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Low vitamin D tied to zoledronic acid reaction in postmenopausal women

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Postmenopausal women with osteoporosis and 25-hydroxyvitamin D levels less than 30 ng/mL were more likely to experience acute-phase reaction after zoledronic acid infusion compared with those with higher vitamin D levels, according to study results.

Marco Massarotti, MD, consultant rheumatologist at University Hospitals of Morecambe Bay NHS Foundation Trust in Lancaster, U.K., and colleagues evaluated data on 153 postmenopausal women with osteoporosis (mean age, 71 years; mean 25-[OH]D level, 32.2 ng/mL) undergoing their first zoledronic acid infusion to confirm the association between acute-phase reaction, or APR, and 25-(OH)D levels and to determine whether the association differs in those previously treated with oral bisphosphonates (n = 68).

The occurrence of fever or the presence of at least one influenza-like symptom, such as fatigue, malaise, bone/muscle pain or headache, that occurred within the 24 to 36 hours from zoledronic acid infusion was used to define acute-phase reaction.

Overall, acute-phase reaction occurred in 44.4% of participants; symptoms included fever plus arthromyalgia (muscle and/or joint pain; 57.4%), fever alone (33.8%), arthromyalgia alone (7.4%) and fever plus diarrhea (1.5%). Symptoms were similar among participants who were and were not previously treated with oral bisphosphonates.

Participants with acute-phase reaction had lower 25-(OH)D levels compared with those without the reaction (26.3 ng/mL vs. 37 ng/mL; P < .0001). More participants with acute-phase reaction had 25-(OH)D levels less than 30 ng/mL compared with those without reaction (65% vs. 31%; P < .0001).

Among participants previously exposed to bisphosphonates, those with acute-phase reaction had lower 25-(OH)D levels compared with those without acute-phase reaction (P = .02), and inadequate 25-(OH)D levels were more common in those with acute-phase reaction (52.5% vs. 26.7%).

“This study confirms that 25-(OH)D levels and, in particular, inadequate 25-(OH)D status, are significant factors for APR after [zoledronic acid] infusion,” the researchers wrote. “Translating our observation into clinical practice, we recommend an adequate supplementation of 25-(OH)D for patients prior to [bisphosphonates] to reduce the risk of APR. Moreover, the role of previous treatment with oral [bisphosphonates] as an independent protective factor for APR should be evaluated in a larger cohort.” – by Amber Cox

Disclosures: Massarotti reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.