Combined alendronate and active vitamin D medication
Cur Med Res Opin. 2006 Sep;22(9):1745-55. Alendronate with and without cholecalciferol for osteoporosis: results of a 15-week randomized controlled trial. Recker R and others. PMID: 16968578. Until recently people taking one of the FDA-approved osteoporosis medications had to take vitamin D as a separate medication, and they needed to take the vitamin D at least one-half hour after taking one of the bisphosphonates such as Actonel or Fosamax. The Recker and others study used a single tablet that contained both cholecalciferol (vitamin D3) and alendronate (Fosamax). The study was a 15-week randomized double-blind, multi-center, active-controlled study. It was conducted in winter when vitamin D levels are normally low for people not taking vitamin D supplements and who were getting minimal sunlight exposure; 35 men and 682 women participated. Those with a serum vitamin D level of >/= 9 ng/ML received either the combination pill or just alendronate for 15 weeks with various serum indicators tested to verify any effect of the active medication. The results showed that vitamin D levels improved in those taking the combination pill but not in those taking only alendronate. Additionally there was no reduction in the antiresorptive efficacy of the alendronate when the vitamin D3 was combined with it. Thus the alendronate should be just as effective in treating osteoporosis whether the vitamin D3 is combined with it or not.
Editor's comments: These results would indicate that it appears safe and effective to combine vitamin D3 with Fosamax so that one fewer pill needs to be taken daily. Note that the study didn't compare participants who were taking vitamin D as a separate medication, which might have been interesting. This is the method used by people with osteoporosis who now take alendronate. A direct comparison of the active D3 to the standard D form of vitamin D could be enlightening. Especially this might inform those now taking a separate pill with, e.g., 800 I.U/day of vitamin D, if they would gain anything from taking the combination pill. The once-weekly Fosamax Plus D has the equivalent of 2800 I.U. of vitamin D. It doesn't really bother me to take the vitamin D as a separate medication, but I might consider the combination pill if it gave me better results than my current regimen. Fosamax Plus D is an approved form of the medication, so if the simplicity of getting two medications in one pill interests you, ask your physician to switch to this. Don't take a vitamin D pill along with your alendronate. No study has tested whether this is effective as far as I know. Remember that vitamin D3 supplements aren't pure vitamin D. My vitamin D supplement also contains cellulose, vegetable magnesium stearate, gelatin, sucrose and other ingredients. These inactive ingredients could interfere with absorption of Fosamax. So either take the approved Fosamax Plus D or wait at least one-half hour to take a vitamin D supplement after taking your Fosamax or Actonel.