The 25(OH)D Level Needed to Maintain a Favorable Bisphosphonate Response is ≥33 Ng/ml

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2012 Jan 13

PMID 22237813

Citations 65

Authors

A S Carmel

A Shieh

H Bang

R S Bockman

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Why only some osteoporotic patients maintain response to prolonged bisphosphonate therapy is unknown. We examined bisphosphonate response and its association with serum 25 hydroxy vitamin D (25(OH)D) level in a "real world" setting. Serum 25(OH)D level was strongly associated with maintaining bisphosphonate response arguing that vitamin D may be involved in optimizing prolonged bisphosphonate therapy.

Introduction: This study examined the maintenance of bisphosphonate response in the "real world" setting and the association between 25(OH)D and bisphosphonate response using an established composite definition of response.

Methods: Postmenopausal women with low bone mineral density (BMD) treated with bisphosphonates were identified from two New York City practices. Patients were excluded for a history of chronic steroid use, metabolic bone disease, or bisphosphonate non-adherence. Patients were categorized as bisphosphonate non-responders if they had a T-score < -3 that persisted between dual-energy X-ray absorptiometry (DEXA) scans, a >3% decrease in BMD, or an incident fracture on bisphosphonate therapy, criteria based on the EUROFORS trial. Demographic and clinical data including mean 25(OH)D levels between DEXA scans were obtained. Mean 25(OH)D levels were compared between responders and non-responders and multiple logistic regression analysis was performed to identify factors associated with non-response.

Results: A total of 210 patients were studied. A favorable response to bisphosphonate therapy was seen in 47% (N = 99/210). Patients with a mean 25(OH)D ≥33 ng/ml had a ~4.5-fold greater odds of a favorable response (P < 0.0001). 25(OH)D level was significantly associated with response - a 1 ng/ml decrease in 25(OH)D was associated with ~5% decrease in odds of responding (odds ratio = 0.95; 95% confidence interval, 0.92-0.98; P = 0.0006).

Conclusions: Patients with a mean 25(OH)D ≥33 ng/ml had a substantially greater likelihood of maintaining bisphosphonate response. This threshold level of 25(OH)D is higher than that considered adequate by the Institute of Medicine, arguing that higher levels may be required for specific therapeutic outcomes.

Citing Articles

Real-life effects of pharmacological osteoporosis treatments on bone mineral density by quantitative computed tomography.

Boehm E, Sauer C, Baur-Melnyk A, Biebl J, Harada S, Wegener B J Bone Miner Metab. 2024; 42(6):741-753.

PMID: 39287797 DOI: 10.1007/s00774-024-01553-z.

When and How to Evaluate Vitamin D Status? A Viewpoint from the Belgian Bone Club.

Lapauw B, Laurent M, Rozenberg S, Body J, Bruyere O, Gielen E Nutrients. 2024; 16(15).

PMID: 39125269 PMC: 11313844. DOI: 10.3390/nu16152388.

High-dose vitamin D to attenuate bone loss in patients with prostate cancer on androgen deprivation therapy: A phase 2 RCT.

Peppone L, Kleckner A, Fung C, Puzas J, Reschke J, Culakova E Cancer. 2024; 130(14):2538-2551.

PMID: 38520382 PMC: 11214601. DOI: 10.1002/cncr.35275.

Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults.

Grygorieva N, Tronko M, Kovalenko V, Komisarenko S, Tatarchuk T, Dedukh N Nutrients. 2024; 16(2).

PMID: 38257163 PMC: 10820145. DOI: 10.3390/nu16020270.

Selective estrogen receptor modulators (SERMs) with vitamin D composite agent can prevent fracture better than SERMs treatment: based on the National Health Claims Database 2017-2019.

Byun S, Kim H, Lee S, Kim S Osteoporos Int. 2024; 35(5):775-783.

PMID: 38240755 DOI: 10.1007/s00198-024-07022-7.

References

Adami S, Isaia G, Luisetto G, Minisola S, Sinigaglia L, Silvestri S . Osteoporosis treatment and fracture incidence: the ICARO longitudinal study. Osteoporos Int. 2008; 19(8):1219-23. DOI: 10.1007/s00198-008-0566-6. View

Adami S, Isaia G, Luisetto G, Minisola S, Sinigaglia L, Gentilella R . Fracture incidence and characterization in patients on osteoporosis treatment: the ICARO study. J Bone Miner Res. 2006; 21(10):1565-70. DOI: 10.1359/jbmr.060715. View

Black D, Thompson D, Bauer D, Ensrud K, Musliner T, Hochberg M . Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab. 2000; 85(11):4118-24. DOI: 10.1210/jcem.85.11.6953. View

Black D, Schwartz A, Ensrud K, Cauley J, Levis S, Quandt S . Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006; 296(24):2927-38. DOI: 10.1001/jama.296.24.2927. View

Harris S, Watts N, Genant H, McKeever C, Hangartner T, Keller M . Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999; 282(14):1344-52. DOI: 10.1001/jama.282.14.1344. View

Dawson-Hughes B, Heaney R, Holick M, Lips P, Meunier P, Vieth R . Estimates of optimal vitamin D status. Osteoporos Int. 2005; 16(7):713-6. DOI: 10.1007/s00198-005-1867-7. View

Koster J, HACKENG W, Mulder H . Diminished effect of etidronate in vitamin D deficient osteopenic postmenopausal women. Eur J Clin Pharmacol. 1996; 51(2):145-7. DOI: 10.1007/s002280050175. View

Holick M . Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging. 2007; 24(12):1017-29. DOI: 10.2165/00002512-200724120-00005. View

Garnero P, Sornay-Rendu E, CHAPUY M, Delmas P . Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res. 1996; 11(3):337-49. DOI: 10.1002/jbmr.5650110307. View

10.

Bonnick S, Shulman L . Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both?. Am J Med. 2006; 119(4 Suppl 1):S25-31. DOI: 10.1016/j.amjmed.2005.12.020. View

11.

Bischoff-Ferrari H, Willett W, Wong J, Giovannucci E, Dietrich T, Dawson-Hughes B . Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005; 293(18):2257-64. DOI: 10.1001/jama.293.18.2257. View

12.

Antoniucci D, Vittinghoff E, Blackwell T, Black D, Sellmeyer D . Vitamin D insufficiency does not affect bone mineral density response to raloxifene. J Clin Endocrinol Metab. 2005; 90(8):4566-72. DOI: 10.1210/jc.2005-0290. View

13.

Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D . A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab. 2001; 86(3):1212-21. DOI: 10.1210/jcem.86.3.7327. View

14.

Ross A, Manson J, Abrams S, Aloia J, Brannon P, Clinton S . The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2010; 96(1):53-8. PMC: 3046611. DOI: 10.1210/jc.2010-2704. View

15.

Braithwaite R, Col N, Wong J . Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003; 51(3):364-70. DOI: 10.1046/j.1532-5415.2003.51110.x. View

16.

van der Wielen R, Lowik M, van den Berg H, de Groot L, Haller J, Moreiras O . Serum vitamin D concentrations among elderly people in Europe. Lancet. 1995; 346(8969):207-10. DOI: 10.1016/s0140-6736(95)91266-5. View

17.

Black D, Delmas P, Eastell R, Reid I, Boonen S, Cauley J . Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007; 356(18):1809-22. DOI: 10.1056/NEJMoa067312. View

18.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

19.

Cook N, Buring J, Ridker P . The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann Intern Med. 2006; 145(1):21-9. DOI: 10.7326/0003-4819-145-1-200607040-00128. View

20.

Bang H, Mazumdar M, Newman G, Bomback A, Ballantyne C, Jaffe A . Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience. Nephrol Dial Transplant. 2009; 24(8):2452-7. PMC: 2734171. DOI: 10.1093/ndt/gfp124. View