The Vitamin D Metabolite Ratio is Associated with Changes in Bone Density and Fracture Risk in Older Adults

ABSTRACTPurposeGaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation.MethodsOlder patients newly prescribed oral bisphosphonates or denosumab between 2012 and 2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age-group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab).ResultsOf 41,901 patients, n=1,569 newly initiated on oral bisphosphonates and n=1,615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95%CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95%CI=0.57-0.89, p<0.01). Older age-group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence while having osteoporosis diagnosed was associated with better denosumab persistence.ConclusionPersistence for osteoporosis medications is sub-optimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary-care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.SUMMARYGaps in pharmacological treatment for osteoporosis can reduce its effectiveness. This study found approximately half of older adults in primary care newly initiated on bisphosphonates or denosumab were still taking these after 2 years. Abrupt discontinuation of denosumab without switching to an alternative is concerning due to increased fracture risk.

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Effect of monthly high-dose vitamin D on bone density in community-dwelling older adults substudy of a randomized controlled trial

Journal of Internal Medicine ◽

10.1111/joim.12651 ◽

2017 ◽

Vol 282 (5) ◽

pp. 452-460 ◽

Cited By ~ 55

Author(s):

I. R. Reid ◽

A. M. Horne ◽

B. Mihov ◽

G. D. Gamble ◽

F. Al-Abuwsi ◽

...

Keyword(s):

Older Adults ◽

Vitamin D ◽

Randomized Controlled Trial ◽

Bone Density ◽

Controlled Trial ◽

Community Dwelling ◽

High Dose ◽

Randomized Controlled ◽

Community Dwelling Older Adults ◽

High Dose Vitamin

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Fibrosis markers, hip fracture risk, and bone density in older adults

Osteoporosis International ◽

10.1007/s00198-015-3269-9 ◽

2015 ◽

Vol 27 (2) ◽

pp. 815-820 ◽

Cited By ~ 4

Author(s):

J. I. Barzilay ◽

P. Bůžková ◽

J. R. Kizer ◽

L. Djoussé ◽

J. H. Ix ◽

...

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Bone Density ◽

Fracture Risk ◽

Hip Fracture Risk

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Total vs. Bioavailable: Determining a Better 25(OH)D Index in Association with Bone Density and Muscle Mass in Postmenopausal Women

Metabolites ◽

10.3390/metabo11010023 ◽

2020 ◽

Vol 11 (1) ◽

pp. 23

Author(s):

Nurdiana Z. Abidin ◽

Soma R. Mitra

Keyword(s):

Older Adults ◽

Vitamin D ◽

Body Composition ◽

Regression Analysis ◽

Bone Density ◽

Postmenopausal Women ◽

Muscle Mass ◽

Stepwise Regression ◽

Intact Parathyroid Hormone ◽

Vitamin D Binding Protein

The concurrent presence of low bone density (osteopenia/osteoporosis) and low muscle mass (sarcopenia) in older adults has led to the recognition of “osteosarcopenia” (OS) as a singular entity. Vitamin D may play important role in the manifestation of OS, in terms of intake, absorption, and bioavailability. Evidence suggests that bioavailable 25(OH)D may be a better indicator of Vitamin D compared to total 25(OH)D due to its weak bind to albumin, increasing its ‘availability’. The aim of this study was to assess total and bioavailable 25(OH)D levels in postmenopausal women and to determine their associations to bone density and muscle mass. We assessed body composition, bone density, and 25(OH)D indices of multiethnic, postmenopausal Malaysian women. A significant and negative correlation was found between body fat % and each index of 25(OH)D. Both bioavailable and total 25(OH)D were positively correlated with serum calcium and negatively correlated with iPTH(intact parathyroid hormone). VDBP(Vitamin D binding protein) level was significantly correlated with bioavailable 25(OH)D level, but not with the total 25(OH)D level. Stepwise regression analysis revealed that bioavailable, but not total, 25(OH)D was significantly correlated to bone density and muscle mass, (where stronger correlation was found with bone density), suggesting its superiority. Nevertheless, the low effect size warrants further studies.

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Vitamin D and bone health outcomes in older age

Proceedings of The Nutrition Society ◽

10.1017/s0029665113002036 ◽

2013 ◽

Vol 72 (4) ◽

pp. 372-380 ◽

Cited By ~ 13

Author(s):

Tom R. Hill ◽

Terence J. Aspray ◽

Roger M. Francis

Keyword(s):

Older Adults ◽

Vitamin D ◽

Health Outcomes ◽

Fracture Risk ◽

Vitamin D Deficiency ◽

Bone Health ◽

Vitamin D Supplementation ◽

Drop Out ◽

Vitamin D Status ◽

Mineral Density

The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.

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