People Taking Bisphosphonates Need More Vitamin D

<"">Bisphosphonates, such as Fosamax, Boniva, and Actonel, have long been linked to potential risks for increased thigh fractures. Now, said the LA Times, it seems that Vitamin D, which collaborates with calcium to strengthen bones, might help increase the power of these osteoporosis medications.

An emerging study, presented just this week, adds to the body of evidence that indicates today’s vitamin D recommendations might be lacking, an issue given that the Institute of Medicine (IOM) issued a report in late 2010 that would not change recommendation on vitamin D dosing, despite that a number of studies have supported the need for an increase, said the LA Times.

The new study was presented at the Endocrine Society’s yearly meeting and indicated that researchers revealed that patients tested with a “circulating vitamin D level greater than 33 nanograms (ng) per milliliter” experienced a seven-fold increased likelihood of responding well to bisphosphonates. Today’s typical vitamin D blood test measures 25-hydroxy vitamin D. The IOM says levels between 20 and 30 ng/ml are generally sufficient for “normal, healthy adults,” wrote the LA Times.

Meanwhile, the study revealed that 83 percent of those with vitamin D levels lower than 20 ng/ml experienced a poor response to bisphosphonates versus 77 percent with levels between 20 and 30 ng/ml, 42 percent with levels of 30 to 40 ng/ml, and 24 percent with levels higher than 40 ng/ml.

“There has been a lot of controversy over the correct vitamin D levels for people to have,” said the lead study author, Dr. Richard Bockman, chief of the endocrine service at Hospital for Special Surgery in New York, quoted the LA Times. “Vitamin D status should be optimized to improve outcomes in patients taking bisphosphonates,” Dr. Bockman added.

Bisphosphonates also include Aclasta, Aredia, Bondronat, Didronel, Fosavance, Reclast, Skelid, and Zometa.

Last year, the U.S. Food & Drug Administration (FDA) asked the manufacturers of bisphosphonates to add information to the “Warnings and Precautions” section of the drugs’ labels describing the risk of atypical thigh fractures. The FDA’s action was prompted by a study of more than 300 women who suffered subtrochanteric (just below the hip joint) or diaphyseal femur (breaks in the long part of the thigh bone) fractures found that 94 percent had taken bisphosphonates for osteoporosis, and most had been on the drugs for five years or more.

A prior Swedish study on which we recently reported also confirmed this risk after looking at 12,777 women aged 55 and older who suffered a fracture of the thigh bone in 2008. Seventy-eight percent of those with the atypical femoral fractures were on bisphosphonates, while only 10 percent who suffered other types of thigh fractures were taking the drugs. The study also found that the women who took the drugs the longest faced the highest risk, while the fracture risk was reduced when patients stopped taking the drugs.

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