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The 25(OH)D level needed to maintain a favorable bisphosphonate response is ≥33 ng/ml

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Abstract

Summary

Why only some osteoporotic patients maintain response to prolonged bisphosphonate therapy is unknown. We examined bisphosphonate response and its association with serum 25 hydroxy vitamin D (25(OH)D) level in a “real world” setting. Serum 25(OH)D level was strongly associated with maintaining bisphosphonate response arguing that vitamin D may be involved in optimizing prolonged bisphosphonate therapy.

Introduction

This study examined the maintenance of bisphosphonate response in the “real world” setting and the association between 25(OH)D and bisphosphonate response using an established composite definition of response.

Methods

Postmenopausal women with low bone mineral density (BMD) treated with bisphosphonates were identified from two New York City practices. Patients were excluded for a history of chronic steroid use, metabolic bone disease, or bisphosphonate non-adherence. Patients were categorized as bisphosphonate non-responders if they had a T-score < −3 that persisted between dual-energy X-ray absorptiometry (DEXA) scans, a >3% decrease in BMD, or an incident fracture on bisphosphonate therapy, criteria based on the EUROFORS trial. Demographic and clinical data including mean 25(OH)D levels between DEXA scans were obtained. Mean 25(OH)D levels were compared between responders and non-responders and multiple logistic regression analysis was performed to identify factors associated with non-response.

Results

A total of 210 patients were studied. A favorable response to bisphosphonate therapy was seen in 47% (N = 99/210). Patients with a mean 25(OH)D ≥33 ng/ml had a ~4.5-fold greater odds of a favorable response (P < 0.0001). 25(OH)D level was significantly associated with response — a 1 ng/ml decrease in 25(OH)D was associated with ~5% decrease in odds of responding (odds ratio = 0.95; 95% confidence interval, 0.92–0.98; P = 0.0006).

Conclusions

Patients with a mean 25(OH)D ≥33 ng/ml had a substantially greater likelihood of maintaining bisphosphonate response. This threshold level of 25(OH)D is higher than that considered adequate by the Institute of Medicine, arguing that higher levels may be required for specific therapeutic outcomes.

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Acknowledgements

This work was supported by The Mary and David Hoar Fellowship of the New York Academy of Medicine and the NIH funded Clinical and Translational Science Center (CTSC) of Weill Cornell Medical College (GRANT UL1-RR024996). We thank Stasi Lubansky, NP, for her work in patient recruitment and data collection.

Conflicts of interest

None.

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Author notes

  1. H. Bang

    Present address: UC-Davis, Department of Public Health Sciences, One Shields Ave., Davis, CA, 95616, USA

Authors and Affiliations

  1. Department of Internal Medicine, Weill Cornell Medical College, 505 East 68th Street, New York, NY, 10021, USA

    A. S. Carmel, A. Shieh & R. S. Bockman

  2. Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, 402 East 67th St., New York, NY, 10065, USA

    H. Bang

  3. Division of Endocrinology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    R. S. Bockman

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  1. A. S. Carmel
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Correspondence to A. S. Carmel.

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Carmel, A.S., Shieh, A., Bang, H. et al. The 25(OH)D level needed to maintain a favorable bisphosphonate response is ≥33 ng/ml. Osteoporos Int 23, 2479–2487 (2012). https://doi.org/10.1007/s00198-011-1868-7

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  • DOI: https://doi.org/10.1007/s00198-011-1868-7

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