Combined alfacalcidol and alendronate therapy
Rheumatol Int. 2007 Jan 11; [Epub ahead of print], Superiority of a combined treatment of Alendronate and Alfacalcidol compared to the combination of Alendronate and plain vitamin D or alfacalcidol alone in established postmenopausal or male osteoporosis (ACC-Trial). Ringe JD and others. PMID: 17216477. This study by Ringe and others appears to be a very significant study that should change the standard treatment regimen for osteoporosis therapy. That is, current standard osteoporosis therapy combines plain vitamin D with calcium supplements and another approved osteoporosis medication, such as one of the bisphosphonates, i.e., alendronate (Fosamax), risedronate (Actonel), or others. The Ringe and others study shows that group C, alfacalcidol when combined with alendronate (ACC), is far superior to the Group B combination of 1,000 IU plain vitamin D/day, plus 1 gm calcium/day, and 70 mg alendronate/week. Additionally the ACC is superior to Group A, 1 mug alfacalcidol/day plus 500 mg calcium/day. The increases in BMD in the lumbar spine for the 2-year study were 3.0%, 5.4% and 9.6% in group A, B, and C, respectively. Increases in BMD in the total hip were 1.5%, 2.4%, and 3.8% in group A, B, and C, respectively. Observed vertebral and non-vertebral fractures during the study were 9, 10, and 2, respectively. Note that this study included both postmenopausal women and men with osteoporosis. Some other important findings were that 80% of the patients in group C were free of back pain at the end of the study. That compared to 30% and 43% in groups B and A, respectively. The safety profiles of each treatment method were similar. The rate of falls in the group C patients was also lower than in the other two groups. The authors state: "In conclusion, the combination therapy with Alendronate and Alfacalcidol exhibited superiority in terms of BMD, overall fractures, rate of falls and back pain over either Alendronate in combination with plain vitamin D or Alfacalcidol alone. Editor's comments: See PMID: 16142849 for another study done in 2005 by this group which showed the importance of using alfacalcidol rather than plain vitamin D to improve increases in BMD when patients are taking corticosteroids. There is a particularly good explanation of why the alfacalcidol, because of how it functions, is superior to vitamin D. Also see PMID 17668216 for additional details regarding the ACC therapy. And note that I have done an Update on alfacalcidol that should provide additional information. But the bottom line from the 2007 Rheumatol Int. study reviewed above is that, if you are being treated for osteoporosis with a bisphosphonate, you should be taking alfacalcidol rather than plain vitamin D. The increases in BMD were almost double those where plain vitamin D was used, back pain improvement was more than doubled, and fractures were decreased considerably. The one negative in this study is that each group included only 30 patients. But the Ringe and others group has done multiple other studies that also show alfacalcidol superior to plain vitamin D for various osteoporosis preventive and treatment therapies. I strongly suggest you discuss this study with your care provider and switch to alfacalcidol if you both agree it will provide superior results.