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. 2021 May 31;13(6):1878.
doi: 10.3390/nu13061878.

Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis

Antonino Catalano  1   2 , Federica Bellone  1 , Domenico Santoro  3 , Peter Schwarz  2 , Agostino Gaudio  4 , Giorgio Basile  1 , Maria Carmela Sottile  1 , Sabrina Atena Stoian  1 , Francesco Corica  1 , Nunziata Morabito  1
Affiliations

Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis

Antonino Catalano et al. Nutrients. .

Abstract

Vitamin D modulates bisphosphonate (BP) efficacy, but its contribution to bone mineral density (BMD) after BP discontinuation is not known. To address this topic, we performed a retrospective analysis of postmenopausal women exposed to alendronate (ALN) to treat osteoporosis who regularly continued the supplementation of cholecalciferol or calcifediol at recommended doses. In the ninety-six recruited women (age 61.1 ± 6.9 years), ALN was administered for 31.2 ± 20.6 months and then discontinued for 33.3 ± 18.9 months. The modification of 25(OH)D serum levels over time was associated with a change of alkaline phosphatase (r = -0.22, p = 0.018) and C-terminal collagen type 1 telopeptide (r = -0.3, p = 0.06). Women in the tertile of the highest increase in 25(OH)D level showed a 5.7% BMD gain at lumbar spine, that was twice as great in comparison with participants with a lower 25(OH)D variation. At a multiple regression analysis, BMD change was associated with time since menopause (ß = 2.28, SE 0.44, p < 0.0001), FRAX score for major fracture (ß = -0.65, SE 0.29, p = 0.03), drug holiday duration (ß = -2.17, SE 0.27, p < 0.0001) and change of 25(OH)D levels (ß = 0.15, SE 0.03, p = 0.0007). After ALN discontinuation, improving the vitamin D status boosts the ALN tail effect on BMD.

Keywords: alendronate; bisphosphonates; drug holiday; osteoporosis; postmenopausal; vitamin D.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of months under treatment with ALN in a cohort of postmenopausal women.
Figure 2
Figure 2
Association between ALN discontinuation—i.e., drug holiday—and BMD change at lumbar spine. (r = −0.27; p = 0.005).
Figure 3
Figure 3
Change of BMD at lumbar spine after ALN discontinuation according to tertiles of serum 25(OH)D variation.
See this image and copyright information in PMC

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