Abstract
It remains unclear whether vitamin D sufficiency optimizes response to bisphosphonate (BP) treatment in postmenopausal osteoporosis. We evaluated the role and possible mechanisms of vitamin D in adequate response to standard BP treatment for postmenopausal osteoporosis. MethodsWe included 120 postmenopausal osteoporotic women (aged 68±8years) receiving BP (alendronate or risedronate) at their annual follow-up, performing complete anamnesis, including treatment adherence, use of vitamin D supplements, and previous falls and fractures during the last year. We analyzed the evolution of bone mineral density (BMD) during this period and serum PTH and 25 hydroxyvitamin D (25(OH)D) and urinary NTx levels. Patients were classified as inadequate responders to antiosteoporotic treatment based on BMD loss>2% and/or the presence of fragility fractures during the last year. ResultsThirty percent of patients showed inadequate response to BP treatment, with significantly lower levels of 25(OH)D (22.4±1.3 vs. 26.6±0.3ng/ml, p=0.01), a higher frequency of 25(OH)D levels<30ng/ml (91% vs. 69%, p=0.019) and higher urinary NTx values (42.2±3.9 vs. 30.9±2.3 nM/mM, p=0.01). Patients with 25(OH)D>30ng/ml had a greater significant increase in lumbar BMD than women with values <30ng/ml (3.6% vs. 0.8%, p<0.05). The probability of inadequate response was 4-fold higher in patients with 25(OH)D<30 (OR, 4.42; 95% CI, 1.22–15.97, p=0.02). ConclusionsInadequate response to BP treatment is frequent in postmenopausal women with osteoporosis as is vitamin D insufficiency, despite vitamin D supplementation. Maintenance of 25(OH)D levels >30ng/ml is especially indicated for adequate response to BP treatment.
Published Version
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