Effect of Denosumab on Bone Density in Postmenopausal Osteoporosis: A Comparison with and Without Calcium Supplementation in Patients on Standard Diets in Korea

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Nov 14

PMID 37959369

Authors

Chaiho Jeong

Jinyoung Kim

Jeongmin Lee

Yejee Lim

Dong-Jun Lim

Ki-Hyun Baek

Jeonghoon Ha

Affiliations

Soon will be listed here.

Abstract

The side effects and safety issues tied to calcium supplementation raise questions about its necessity in osteoporosis treatment. We retrospectively evaluated 189 postmenopausal osteoporosis patients treated with denosumab for 12 months. Patients exhibited neither renal dysfunction nor compromised general dietary intake. Patients were divided into three groups as follows: group A, weekly vitamin D 7000 IU; group B, daily vitamin D 1000 IU with elemental calcium 100 mg; and group C, daily vitamin D 1000 IU with elemental calcium 500 mg. All groups showed significant increases in bone density: +6.4 ± 4.7% for the lumbar spine, +2.2 ± 3.5% for the femoral neck, and +2.4 ± 3.8% for the total hip in group A; +7.0 ± 10.9% for the lumbar spine, +2.3 ± 5.2% for the femoral neck, and +2.4 ± 3.8% for the total hip in group B; and + 6.7 ± 8.7% for the lumbar spine, +2.5 ± 8.4% for the femoral neck, and +2.3 ± 4.0% for the total hip in group C. Serum calcium levels increased over time in all three groups with no significant difference. Changes in CTX and P1NP levels did not differ between the groups (all > 0.05). With regular dietary intake, calcium supplementation levels showed no significant effect on bone density, bone marker changes, or hypocalcemia incidence during denosumab treatment.

References

Han A, Park Y, Lee Y, Park S, Park C . Position Statement: Vitamin D Intake to Prevent Osteoporosis and Fracture in Adults. J Bone Metab. 2022; 29(4):205-215. PMC: 9760769. DOI: 10.11005/jbm.2022.29.4.205. View

Diez A, Carbonell C, Calaf J, Caloto M, Nocea G . Observational study of treatment compliance in women initiating antiresorptive therapy with or without calcium and vitamin D supplements in Spain. Menopause. 2011; 19(1):89-95. DOI: 10.1097/gme.0b013e318223bd6b. View

Lewis J, Zhu K, Prince R . Adverse events from calcium supplementation: relationship to errors in myocardial infarction self-reporting in randomized controlled trials of calcium supplementation. J Bone Miner Res. 2011; 27(3):719-22. DOI: 10.1002/jbmr.1484. View

Gregson C, Armstrong D, Bowden J, Cooper C, Edwards J, Gittoes N . UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022; 17(1):58. PMC: 8979902. DOI: 10.1007/s11657-022-01061-5. View

Kenny A, Prestwood K, Biskup B, Robbins B, Zayas E, Kleppinger A . Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women. Osteoporos Int. 2004; 15(4):290-4. DOI: 10.1007/s00198-003-1567-0. View

Lee Y, Chang J, Min Y, Byun D, Park Y, Ha Y . Low calcium and vitamin D intake in Korean women over 50 years of age. J Bone Miner Metab. 2016; 35(5):522-528. DOI: 10.1007/s00774-016-0782-7. View

Eastell R, Rosen C, Black D, Cheung A, Murad M, Shoback D . Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019; 104(5):1595-1622. DOI: 10.1210/jc.2019-00221. View

Zarzour F, Didi A, Almohaya M, Kendler D . Cardiovascular Impact of Calcium and Vitamin D Supplements: A Narrative Review. Endocrinol Metab (Seoul). 2023; 38(1):56-68. PMC: 10008654. DOI: 10.3803/EnM.2022.1644. View

Bargagli M, Ferraro P, Vittori M, Lombardi G, Gambaro G, Somani B . Calcium and Vitamin D Supplementation and Their Association with Kidney Stone Disease: A Narrative Review. Nutrients. 2021; 13(12). PMC: 8707627. DOI: 10.3390/nu13124363. View

10.

Bonnick S, Broy S, Kaiser F, Teutsch C, Rosenberg E, Delucca P . Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density. Curr Med Res Opin. 2007; 23(6):1341-9. DOI: 10.1185/030079907X188035. View

11.

Nilas L, Christiansen C, RODBRO P . Calcium supplementation and postmenopausal bone loss. Br Med J (Clin Res Ed). 1984; 289(6452):1103-6. PMC: 1443268. DOI: 10.1136/bmj.289.6452.1103. View

12.

Reid I, Bolland M, Grey A . Effect of calcium supplementation on hip fractures. Osteoporos Int. 2008; 19(8):1119-23. DOI: 10.1007/s00198-008-0563-9. View

13.

Li K, Wang X, Li D, Chen Y, Zhao L, Liu X . The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health. Clin Interv Aging. 2018; 13:2443-2452. PMC: 6276611. DOI: 10.2147/CIA.S157523. View

14.

Grant A, Avenell A, Campbell M, McDonald A, MacLennan G, McPherson G . Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005; 365(9471):1621-8. DOI: 10.1016/S0140-6736(05)63013-9. View

15.

Dawson-Hughes B, Harris S, Krall E, Dallal G . Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997; 337(10):670-6. DOI: 10.1056/NEJM199709043371003. View

16.

Rhee Y, Chang D, Ha J, Kim S, Lee Y, Jo E . Real-World Safety and Effectiveness of Denosumab in Patients with Osteoporosis: A Prospective, Observational Study in South Korea. Endocrinol Metab (Seoul). 2022; 37(3):497-505. PMC: 9262695. DOI: 10.3803/EnM.2022.1427. View

17.

Castelo-Branco C, Cortes X, Ferrer M . Treatment persistence and compliance with a combination of calcium and vitamin D. Climacteric. 2009; 13(6):578-84. DOI: 10.3109/13697130903452804. View

18.

Dawson-Hughes B, Dallal G, Krall E, Sadowski L, Sahyoun N, Tannenbaum S . A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med. 1990; 323(13):878-83. DOI: 10.1056/NEJM199009273231305. View

19.

Myung S, Kim H, Lee Y, Choi Y, Oh S . Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients. 2021; 13(2). PMC: 7910980. DOI: 10.3390/nu13020368. View

20.

Kim K, Choi S, Lim S, Moon J, Kim J, Kim S . Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008-2010). J Clin Endocrinol Metab. 2014; 99(7):2409-17. DOI: 10.1210/jc.2014-1006. View