1. ¹Breast Unit, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy
2. ²Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
3. ³Medicina Interna e, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino – Azienda Ospedaliera San Luigi di Orbassano, Orbassano, Italy
4. ⁴Oncologia Medica, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino – Azienda Ospedaliera San Luigi di Orbassano, Orbassano, Italy

Correspondence: Professor A Berruti, E-mail: alfredo.berruti@gmail.com

Received 9 January 2008; Revised 31 March 2008; Accepted 9 April 2008.

Abstract

Persistent circadian rhythm of bone turnover in bone metastatic breast cancer suggests greater skeletal retention of bisphosphonates if administered in the night. We assessed differential effects of night vs morning administration of zoledronic acid (ZA) on bone turnover. Forty-four breast cancer patients with bone metastases were randomised to receive intravenous ZA (4 mg) at 1100 or 2300 hours every 28 days for four times. Urinary concentration N-telopeptide of type-I collagen (NTX) and deoxypyridinolines, and serum C-telopeptide of type-I collagen (CTX), bone alkaline phosphatase (ALP), osteocalcin and Parathyroid hormone (PTH) was measured in the morning at baseline and after 4, 7, 14, 28, 56 and 84 days. Urinary ZA concentration was also measured. Zoledronic acid caused significant decreases of NTX and CTX (P<0.001), without any difference in percent changes between night and morning arms. Bone ALP and osteocalcin were also significantly affected by ZA (P=0.001), without any difference between arms. Parathyroid hormone significantly increased in both the arms; PTH increase was lower in the night arm (P=0.001). From the second administration onwards, urinary ZA level was significantly higher in the night arm (P<0.01). Administration of ZA at two opposite phases of the circadian cycle causes similar changes of bone-turnover marker levels, but has differential effects on the level of serum PTH.