Adequate 25OHD levels prevent acute phase reaction after BP infusion in PDB patients

Paget’s Disease of Bone (PDB) is characterized by elevated bone turnover and bone deformities at affected skeletal sites. Current therapies for PDB consist of intravenous infusion of bisphosphonates (BPs), chemical compounds, which have high affinity for the main bone component, the hydroxiapatite. The main effect of BPs is to strongly inhibit the osteoclasts, the cells assigned to the bone resorption and remodelling. However, intravenous use of BPs often causes, especially at first use, an acute phase reaction (APR) characterized by pyrexia, musculoskeletal pain and flu-like symptoms. A recent paper published by the ECTS Academy member, Daniela Merlotti, shed light on the relationship between the Vit D deficiency and the onset of APR in PDB patients treated (for the first time or not) with BPs. The Authors conducted two different studies: in the first retrospective study, they observed that PDB patients with Vit D deficiency had developed more frequently a severe APR after BPs infusion. In the second prospective study, the Authors treated PDB patients with Vit D supplementation (to restore the physiological Vit D level) before BPs infusions, and observed a risk to develop an APR up to 2,5 lower with respect to what observed in the retrospective study group. Importantly, results from this study clearly indicate that low Vit D levels are associated with a higher prevalence¬† of other common adverse events occurring after BPs infusion, such as hypocalcaemia and that a preventive supplementation with Vit D in PDB subjects with circulating levels below 20 ng/ml is able to prevent both APR and hypocalcaemia in most cases. These results are relevant for the management of PDB patients, and reinforces the general recommendation to have an adequate level of Vit D.

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