metylallyl pyrophosphate , which are potent agonists of the cd T cell receptor. These antigens induce the activation of cd T cells and the production of the proinflammatory cytokines involved in the pathogenesis of APR by the same lymphocytes .The study of Reid characterized the APR and determined its frequency and the risk Ostarine factors for its development after zoledronic acid. A correlation between 25D levels and the onset of APR has been observed . Since the vitamin D receptor has been described in cells of the immune system, some hypotheses about the possible role of cholecalciferol and its active metabolite on immune modulation have been proposed. In vitro and in vivo studies demonstrate that vitamin D promotes innate immunity and exerts an inhibitory action on the adaptative immune system .
Interestingly, in vitro, upregulation of VDR expression following the activation of cd T cells caused by IPP has been demonstrated, and it was noted that vitamin D is able to regulate negatively the expansion of cd T cells and their production of IFN c . The aim of this study was to test the effects of a bolus of vitamin D on the incidence of APR and intensity of musculoskeletal KSP Inhibitors pain in women with postmenopausal osteoporosis undergoing infusion of zoledronic acid ; the secondary outcome was changes in inflammatory markers. Supplementation with vitamin D is a desirable complement to appropriate treatment of postmenopausal osteoporosis, and a bolus of vitamin D allows a faster and significant rise in plasma levels of 25D that is useful to obtain extraskeletal effects, which usually require concentrations of vitamin D greater than those seen in the general population .
Materials and Methods Sixty postmenopausal women attending pericardium the Centre for Prevention, Diagnosis and Treatment of Osteoporosis in the Department of Internal Medicine of the University of Messina were enrolled in this randomized, double blinded, placebo controlled pilot study. They were consecutive osteoporotic patients, with or without prevalent vertebral fractures, or osteopenic patients with at least one mild prevalent vertebral fracture , who required i.v. therapy with N BPs. Following WHO criteria, osteopenia and osteoporosis were diagnosed referring to the T score: bone mineal density was measured in all patients by a dual energy X ray absorptiometric densitometer at the lumbar spine in AP projection and at the femoral neck.
Women who had, at least at one site, a T score between 1 and 2.5 SD were considered osteopenic, and those with values 2.5 SD were considered osteoporotic. Vertebral fractures were detected at morphometric examination of the dorsal and lumbar spine and classified according to Genant’s classification of vertebral fractures . Patients with cancer, autoimmune diseases, immunodeficiency, chronic treatment with corticosteroids, liver or renal failure, or hypo or hypercalcemia and women previously treated with intravenous N BPs were excluded from this study. A measurement of serum 25D, within the month prior to enrollment, had to be available for each patient since these women were previously treated with cholecalciferol . Patients with low or normal values of 25D were recruited. Previous oral or intramuscular treatment with N BPs was not an exclusion criterion. Patients were randomized into two groups using a computer generated randomization schedule in the order in which they were enrolled in the study.