Written by Chrystal Moulton, Staff Writer. BMD at the lumbar spine increased significantly over each tertile of serum vitamin D concentration (P < 0.05).
Individuals with osteoporosis are commonly prescribed anti-resorptive drugs called bisphosphonates 1. Although effective at increasing bone mineral density (BMD), serious side effects can occur with long term use including osteonecrosis of the jaw and atypical fractures 2,3. Periodic discontinuation of the drug is suggested to avoid these side effects especially since the expected pharmacological effects continue even after discontinuation 3. Since vitamin D has been shown to support bone health by assisting in calcium homeostasis 4, researchers wanted to see if serum vitamin D also played a role in supporting the pharmacological effect of bisphosphonates. In the current study, researchers analyzed existing clinical data to determine if vitamin D status in osteoporotic women played a role in the residual pharmacological effects of alendronate (a bisphosphonate) after discontinuation 5.
In this retrospective study, researchers analyzed data on postmenopausal women prescribed alendronate for osteoporosis between 2006 and 2016. Patient data was included if bone mineral density (BMD) before and after alendronate treatment was available and if the patient maintained treatment for at least 6 months. Patients were provided a daily dose of 70 mg alendronate and an oral cholecalciferol (25,000 IU every two weeks) or calcifediol (100 – 125 µg weekly). Participants continued to take either oral cholecalciferol or calcifediol even after discontinuing alendronate treatment until the end of the trial. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck. Alkaline phosphatase (ALP) and C- terminal collagen type 1 telopeptide (CTX) were also measured along with serum vitamin D, calcium, phosphorus, and creatinine. Participant data was organized into tertiles based on serum vitamin D level.
Out of 1686 patients, 96 women aged 61.1 years old who were prescribed alendronate were included in this study. The length of alendronate treatment was 31.2 ± 20.6 months and length of discontinuation was 33.3 ± 18.9 months over the whole study group (n=96). BMD at the femoral neck increased significantly at the highest serum vitamin D level (tertile 3) [D1: 0.45 0.31 versus D3: 0.63 0.16 g/cm 2, P = 0.002]. BMD at the lumbar spine increased significantly over each tertile of serum vitamin D concentration (P < 0.05). Baseline serum vitamin D was not associated with changes in the femoral neck and lumbar spine after discontinuing alendronate treatment. However, changes in serum vitamin D concentration over time was inversely associated with C- terminal collagen type 1 telopeptide (CTX) [r =- 0.3, P = 0.06] and in alkaline phosphatase (ALP) [ r =- 0.22, P = 0.018]. Patients in the highest tertile of serum vitamin D levels had a BMD gain of 5.7%. Using multiple regression analysis, researchers also found that BMD change at the lumbar spine was significantly associated with time since menopause [beta= 2.28, P <0.0001], change in serum vitamin D levels (beta = 0.15, P = 0.0007), alendronate discontinuation period (beta= – 2.1, P <0.0001), and FRAX score (beta = – 0.65, P= 0.03) [ for major fractures].
Overall, researchers observed an increase in BMD at the lumbar spine as serum vitamin D levels increased, even after discontinuation of alendronate treatment. Additional studies would be needed to verify these findings.
Source: Catalano, Antonino, Federica Bellone, Domenico Santoro, Peter Schwarz, Agostino Gaudio, Giorgio Basile, Maria Carmela Sottile, Sabrina Atena Stoian, Francesco Corica, and Nunziata Morabito. “Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis.” Nutrients 13, no. 6 (2021): 1878.
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).
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Posted July 27, 2021.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
References:
- Kataoka Y, Luo Y, Chaimani A, et al. Cumulative network meta-analyses, practice guidelines, and actual prescriptions for postmenopausal osteoporosis: a meta-epidemiological study. Arch Osteoporos. 2020;15(1):21.
- Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2010;25(11):2267-2294.
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- Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama. 2005;293(18):2257-2264.
- Catalano A, Bellone F, Santoro D, et al. Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis. Nutrients. 2021;13(6).
