Vitamin D and bisphosphonates combo improve BMD in patients with postmenopausal osteoporosis: Study

A new study published in the Frontiers in Pharmacology found that combining vitamin D with bisphosphonates led to positive effects on bone mineral density (BMD) in postmenopausal osteoporosis patients. One of the most prevalent illnesses among the elderly is osteoporosis, which affects nearly 30% of postmenopausal women worldwide and has a prevalence of 18.3%.

As of now, there is disagreement about whether vitamin D (VitD) and bisphosphonates work better together than they do alone to treat postmenopausal osteoporosis. Thereby, to integrate the current information and further explore whether the combination use of vitamin D and bisphosphonates is preferable to monotherapy in treating osteoporosis in postmenopausal women, Yang Y and colleagues set out to perform a meta-analysis of recent pertinent studies.

To find randomized controlled trials (RCTs) comparing the effects of vitamin D or bisphosphonates alone versus their combination therapy in the treatment of postmenopausal osteoporosis, this research conducted a thorough search of EMBASE, PubMed, the Cochrane Library, and Web of Science through February 1, 2024.

The standardized mean difference (SMD) and 95% confidence intervals (CI) were used to represent the changes in mean values and percentage changes for bone resorption indicators, bone formation markers, bone mineral density, and bone mineral metabolism markers. The I[2] test was used to quantitatively characterize heterogeneity. Sensitivity analysis for data with notable heterogeneity were then conducted. The kind of monotherapy employed was the basis for subgroup analysis, and possible publication bias was evaluated.

In comparison to the monotherapy group, the analysis showed that the combination of vitamin D and bisphosphonates had a more noticeable effect on raising serum levels of alkaline phosphatase (ALP), 25-hydroxyvitamin D (25-OH-VD), and calcium (sCa), while lowering levels of serum C-terminal telopeptide of type I collagen (sCTX), bone-specific alkaline phosphatase (sBALP), and urinary N-telopeptide of type I collagen (UriNTX).

However, in terms of raising osteocalcin levels, the combination of vitamin D and bisphosphonates did not provide a discernible benefit over monotherapy. The percentage increases in parathyroid hormone (PTH) and the mean changes in osteocalcin, UriNTX, and sCa were not statistically significant (p > 0.05). Overall, this meta-analysis indicates that the combined therapy of vitamin D and bisphosphonates has a greater positive impact on indicators related to bone calcium metabolism and bone mineral density than monotherapy.

Source:

Yang, Y., Yang, M., Su, X., & Xie, F. (2024). Efficacy of combination therapy of vitamin D and bisphosphonates in the treatment of postmenopausal osteoporosis: a systematic review and meta-analysis. In Frontiers in Pharmacology (Vol. 15). Frontiers Media SA. https://doi.org/10.3389/fphar.2024.1422062