Men's Osteoporosis Support Group

Gastrointestinal safety of bisphosphonates and a cross-sectional study on vitamin D

Osteoporos Int. 2009 Mar 6. [Epub ahead of print]. Comparative gastrointestinal safety of weekly oral bisphosphonates. Cadarette SM and others, PMID: 19266138. This study compared the incidence of upper gastrointestinal (GI) bleeding that required hospitalization within 120 days of 10,420 individuals starting either Fosamax (alendronate) or Actonel (risedronate). The mean age of the users was 79 and the study group was 95% women. The findings were that there were 31 cases of upper GI bleeding in the group with no difference between the hospitalized individuals taking the two medications. The authors concluded: "We found no important difference in gastrointestinal safety between weekly oral bisphosphonates."

Editor's comments: This is just one more study that has found the once-weekly bisphosphonate dosing to be non-irritating to the GI system. I reviewed this topic in a recent Update if you want more information. I don't have a copy of the full article which might explain the findings for each of the hospitalized individuals which would be helpful. But the rate of 31 bleeds per 10,420 individuals seems within the normal expected rate for 79-year-old people. A recent review by van Leerdame ME noted that 50% of upper GI bleeding is due to peptic ulcer disease which is correlated with NSAIDs and h.pylori infection and unrelated to bisphosphonate usage.

Bone. 2009 Mar 2. [Epub ahead of print]. Behavioural and physical characteristics associated with vitamin D status in women. Pasco JA and others. PMID: 19264157. This Australian cross-sectional study looked at several physical and behavioral characteristics of community-living women of all ages and then related those to serum 25-hydroxyvitamin D (25OHD) levels. The goal was to correlate these findings to hypertension and bone health. The study included 861 women aged 20-92 who were tested for serum 25OHD, parathyroid hormone (PTH), blood pressure, bone mineral density (BMD) and anthropometry. Using a questionnaire they documented several lifestyle factors: diet, smoking, medication use, socio-economic status, residence, education, occupation, and physical activity. The findings included: "BMD was associated with serum 25OHD at the spine, hip and whole body; no associations were detected at the forearm and no other characteristics were identified as confounders." Additionally, those with high vitamin D levels had healthy body habits, led an active lifestyle, had less hypertension, fewer bone deficits, and didn't have elevated PTH (parathyroid hormone levels). In contrast, those with excess weight or who smoked had lower vitamin D levels.

Editor's comments. There are few if any surprises in this study. It is mainly a reinforcement of what we know: a healthy lifestyle promotes healthy physical characteristics. These include normal vitamin D levels, normal bone mineral density and blood pressure in the normal range. Smoking, obesity and similar lifestyles or traits would not necessarily be expected to be harbingers of good health. So lead an active, healthy life to help maintain normal vitamin D status and BMD.

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