Research article

Effect of vitamin D on bone mineral density of elderly patients with osteoporosis responding poorly to bisphosphonates

George A Heckman¹ , Alexandra Papaioannou¹ , Rolf J Sebaldt^2,3 , George Ioannidis⁴ , Annie Petrie⁵ , Charlie Goldsmith^6,7 and Jonathan D Adachi⁸

¹  Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada

²  Department of Medicine, McMaster University, Hamilton, Ontario, Canada

³  Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ontario, Canada

⁴  Charlton Medical Centre, Hamilton, Ontario, Canada

⁵  Department of Medicine, McMaster University, Hamilton, Ontario, Canada

⁶  Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

⁷  Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ontario, Canada

⁸  Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada

author email corresponding author email

BMC Musculoskeletal Disorders 2002, 3:6doi:10.1186/1471-2474-3-6

Published:	8 February 2002

Abstract

Background

Bisphosphonates are indicated in the prevention and treatment of osteoporosis. However, bone mineral density (BMD) continues to decline in up to 15% of bisphosphonate users. While randomized trials have evaluated the efficacy of concurrent bisphosphonates and vitamin D, the incremental benefit of vitamin D remains uncertain.

Methods

Using data from the Canadian Database of Osteoporosis and Osteopenia (CANDOO), we performed a 2-year observational cohort study. At baseline, all patients were prescribed a bisphosphonate and counseled on vitamin D supplementation. After one year, patients were divided into two groups based on their response to bisphosphonate treatment. Non-responders were prescribed vitamin D 1000 IU daily. Responders continued to receive counseling on vitamin D.

Results

Of 449 patients identified, 159 were non-responders to bisphosphonates. 94% of patients were women. The mean age of the entire cohort was 74.6 years (standard deviation = 5.6 years). In the cohort of non-responders, BMD at the lumbar spine increased 2.19% (p < 0.001) the year after vitamin D was prescribed compared to a decrease of 0.55% (p = 0.36) the year before. In the cohort of responders, lumbar spine BMD improved 1.45% (p = 0.014) the first year and 1.11% (p = 0.60) the second year. The difference between the two groups was statistically significant the first year (p < 0.001) but not the second (p = 0.60). Similar results were observed at the femoral neck but were not statistically significant.

Conclusion

In elderly patients with osteoporosis not responding to bisphosphonates, vitamin D 1000 IU daily may improve BMD at the lumbar spine.