Vitamin D insufficiency does not affect response of bone mineral density to alendronate

D. M. Antoniucci, E. Vittinghoff, L. Palermo, D. M. Black, D. E. Sellmeyer

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


We investigated whether osteoporosis therapy with alendronate in postmenopausal patients is equally effective in patients who are vitamin D insufficient as in those who are vitamin D sufficient. We found that vitamin D insufficiency is common among patients with low bone density but that vitamin D insufficiency did not impair response to alendronate. Introduction: Treatment of vitamin D deficiency leads to significant improvements in bone mineral density (BMD); however, whether insufficiency affects BMD's response to bisphosphonate therapy is unknown. Methods: To determine whether vitamin D insufficiency at initiation of alendronate therapy for low BMD affects treatment efficacy, we used data from 1,000 postmenopausal women randomly selected from the vertebral fracture arm (n=2,027) of the placebo-controlled Fracture Intervention Trial of alendronate. Participants were randomly assigned to placebo (50%) or alendronate therapy and most (83%) to calcium (500 mg/day) and cholecalciferol (250 IU/day). We measured serum 25-hydroxy vitamin D (25OHD) at enrollment, then categorized baseline vitamin D status according to 25OHD concentration (≤10 ng/ml=deficient; >10 but ≤30 ng/ml=insufficient; >30 ng/ml=sufficient) and used linear regression to compare the effects of alendronate treatment among these categories. Results and conclusion: At baseline, participants were vitamin D sufficient (14%), insufficient (83%), and deficient (2%). We found that BMD response to therapy at total hip or spine did not vary by vitamin D status at baseline (p for heterogeneity=0.6). We determined that vitamin D insufficiency is common among participants with low BMD. However, vitamin D status at initiation of therapy does not affect BMD's response to alendronate, when it is coadministered with cholecalciferol and calcium.

Original languageEnglish (US)
Pages (from-to)1259-1266
Number of pages8
JournalOsteoporosis International
Issue number7
StatePublished - Jul 2009
Externally publishedYes


  • Alendronate
  • Bone mineral density
  • Osteoporosis
  • Vitamin D deficiency
  • Vitamin D repletion

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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