ABSTRACT: OBJECTIVE: Patients treated with intravenous zoledronate frequently experience an acute phase reaction (APR) characterized by flu-like symptoms and increased levels of inflammatory cytokines. We aimed to define the role of various cytokines/adipocytokines in zoledronate-induced APR and develop a prognostic model for its prediction. PATIENTS AND MEASUREMENTS: Fifty-one postmenopausal women with low bone mass were subjected to zoledronate intravenous infusion. Patients were divided into those who experienced APR (APR+) and those who did not (APR-). APR was clinically defined by body temperature and the visual analog pain scale for musculoskeletal symptoms. White blood cell count, leucocytic subpopulations, C-reactive protein, interleukin-6, tumor necrosis factor-alpha, visfatin, resistin and leptin were measured before and 48 hours following the infusion. The quantitative insulin sensitivity check index (QUICKI) and homeostasis model of assessment - insulin resistance (HOMA-IR) were calculated to assess insulin sensitivity and resistance, respectively. RESULTS: APR+ patients were younger and had lower baseline visfatin and higher baseline lymphocytes and phosphate compared to APR- patients. QUICKI decreased and HOMA-IR increased in APR+ patients while remained unchanged in APR- patients. In binary logistic regression analysis a model containing previous bisphosphonate treatment, age, body mass index, lymphocytes and visfatin, which predicted zoledronate-induced APR with 85.7% sensitivity and 73.9% specificity, was selected. In this model, lymphocytes (p=0.010) and visfatin (p=0.029) at baseline could independently predict APR. CONCLUSIONS: Zoledronate-induced APR is associated with serum increases of pro-inflammatory cytokines and an increase of insulin resistance. Patients with higher lymphocytes and lower visfatin levels at baseline are at higher risk for APR. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 06/2012; · 3.17 Impact Factor