Document Detail

Increase in bone mass after correction of vitamin D insufficiency in bisphosphonate-treated patients.
MedLine Citation:
PMID:  18463035     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the relative contribution of vitamin D insufficiency to loss of bone mineral density (BMD) in patients taking bisphosphonates. METHODS: Patients were eligible for inclusion if they had osteoporosis or osteopenia and demonstrated a decline in BMD during the preceding year while taking stable doses of alendronate or risedronate, plus supplemental calcium and vitamin D. Patients with previously known secondary causes of osteoporosis were excluded from the study. Eligible patients underwent prospective measurement of bilateral hip and lumbar spine BMD by dual-energy x-ray absorptiometry, serum 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, and thyroid-stimulating hormone (thyrotropin), and urinary calcium:creatinine ratio. RESULTS: Annual BMD was assessed in 175 previously bisphosphonate-responsive patients with low BMD. Of the 175 patients, 136 (78%) had either a significant interval increase or no change in BMD, whereas 39 (22%) had a significant decrease. Of the 39 patients who lost BMD, 20 (51%) had vitamin D insufficiency (25-OHD <30 ng/mL). After a single course of orally administered vitamin D2 (500,000 IU during a 5-week period), the 25-OHD level returned to normal in 17 of the 20 vitamin D-insufficient patients and was associated with significant (P<.02) 3.0% and 2.7% increases in BMD at the lumbar spine and the femoral neck, respectively. Failure to normalize the serum 25-OHD level was associated with further loss of BMD. CONCLUSION: Vitamin D insufficiency was the most frequently identified cause of bone loss in patients with declining BMD during bisphosphonate therapy. Correction of vitamin D insufficiency in these patients led to a significant rebound in BMD.
Jordan L Geller; Bei Hu; Susan Reed; James Mirocha; John S Adams
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  14     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-08-11     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  293-7     Citation Subset:  IM    
Burns and Allen Research Institute and Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90048, USA.
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MeSH Terms
Absorptiometry, Photon
Aged, 80 and over
Alendronate / pharmacology,  therapeutic use
Bone Density / drug effects*,  physiology
Bone Density Conservation Agents / pharmacology,  therapeutic use*
Bone Diseases, Metabolic / drug therapy*,  etiology,  physiopathology
Cohort Studies
Diphosphonates / pharmacology,  therapeutic use*
Etidronic Acid / analogs & derivatives,  pharmacology,  therapeutic use
Follow-Up Studies
Middle Aged
Osteoporosis / drug therapy*,  etiology,  physiopathology
Retrospective Studies
Treatment Outcome
Vitamin D / analogs & derivatives,  blood
Vitamin D Deficiency / blood,  complications,  drug therapy*
Grant Support
Reg. No./Substance:
0/Bone Density Conservation Agents; 0/Diphosphonates; 105462-24-6/risedronic acid; 1406-16-2/Vitamin D; 2809-21-4/Etidronic Acid; 64719-49-9/25-hydroxyvitamin D; 66376-36-1/Alendronate
Comment In:
Endocr Pract. 2008 Sep;14(6):797-8; author reply 798   [PMID:  19004131 ]

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