Evaluation of ergocalciferol or cholecalciferol dosing, 1,600 IU daily or 50,000 IU monthly in older adults.

Context: Whether ergocalciferol (D(2)) and cholecalciferol (D(3)) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial.

Objective: The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2) or D(3) on circulating 25(OH)D and serum and urinary calcium.

Design, Setting And Participants: In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D(2) or D(3) for 1 yr.

Randomized trial of adjuvant zoledronic acid in postmenopausal women with high-risk breast cancer.

Purpose: We present the results of a randomized multicenter clinical trial of adjuvant zoledronic acid (ZA) in postmenopausal women with high-risk breast cancer. The primary objective was change in bone mineral density (BMD) at the lumbar spine and femoral neck at 1 year. Secondary objectives included change in calcaneal BMD, disease-free survival (DFS), overall survival (OS), and toxicity.

Vitamin D toxicity due to a commonly available "over the counter" remedy from the Dominican Republic.

Context: Hypercalcemia in ambulatory patients is occasionally caused by vitamin D toxicity.

Objective: We report nine patients presenting to Columbia University Medical Center with hypercalcemia due to a supplement from the Dominican Republic containing massive amounts of vitamin D.

Methods: Case histories and laboratory evaluation (calcium, PTH, vitamin D metabolites) are discussed in the context of other published cases of vitamin D toxicity.

The vitamin D analogue 2MD increases bone turnover but not BMD in postmenopausal women with osteopenia: results of a 1-year phase 2 double-blind, placebo-controlled, randomized clinical trial.

Most osteoporosis drugs act by inhibiting bone resorption. A need exists for osteoporosis therapies that stimulate new bone formation. 2-Methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D(3) (2MD) is a vitamin D analogue that potently stimulates bone formation activity in vitro and in the ovariectomized rat model.

Effect of phylloquinone supplementation on glucose homeostasis in humans.

Background: Under-γ-carboxylated osteocalcin (ucOC) increases insulin secretion and decreases glucose concentrations in mice.

Objective: We determined whether changes in ucOC concentrations in humans were associated with changes in insulin and glucose concentrations.

Design: Twenty-one community-dwelling postmenopausal women received 1 mg phylloquinone daily for 12 mo (experimental group), and 21 subjects were treated with a placebo during the same period (control group).

Current status of clinical 25-hydroxyvitamin D measurement: an assessment of between-laboratory agreement.

Background: Historically, methodological differences and lack of standardization led to between-laboratory variability in 25(OH)D results. Recent observations raised concern about persisting variability. This quality assurance exercise investigated 25(OH)D result comparability between laboratories.

Jumping mechanography: a potential tool for sarcopenia evaluation in older individuals.

Muscular function declines with advancing age and is associated with increased risk for falls and fragility fractures. No single methodology ideally quantitatively evaluates this decline. Jumping mechanography (JM) may prove useful to quantitatively measure muscular function in older adults.

Low vitamin D status: definition, prevalence, consequences, and correction.

Vitamin D is obtained from cutaneous production when 7-dehydrocholesterol is converted to vitamin D(3) (cholecalciferol) by ultraviolet B radiation or by oral intake of vitamin D(2) (ergocalciferol) and D(3). An individual's vitamin D status is best evaluated by measuring the circulating 25-hydroxyvitamin D (25(OH)D) concentration. Although controversy surrounds the definition of low vitamin D status, there is increasing agreement that the optimal circulating 25(OH)D level should be approximately 30 to 32 ng/mL or above.

"Evidence-based" or "logic-based" medicine?

Low trauma fractures are the cardinal manifestation of osteoporosis. Their occurrence supersedes bone mineral density in deciding whether specific therapy is warranted. We therefore disagree with the notion that a densitometric threshold for treatment should be applied to patients over age 50 who suffer low trauma distal radius fracture.

Once-weekly dose of 8400 IU vitamin D(3) compared with placebo: effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency.

Background: Vitamin D insufficiency, which is prevalent in older individuals, is associated with bone and muscle weakness and falls.

Objective: We examined the effects of a weekly dose of 8400 IU vitamin D(3) on postural stability, muscle strength, and safety.

Design: In this double-blind trial, subjects aged > or =70 y with serum 25-hydroxyvitamin D [25(OH)D] concentrations < or =20 but > or =6 ng/mL were randomly assigned to receive a weekly dose of 8400 IU vitamin D(3) (n = 114) or a placebo (n = 112).

Efficacy and safety of monthly ibandronate in men with low bone density.

Introduction: Monthly oral ibandronate is indicated for the prevention and treatment of osteoporosis in postmenopausal women. The STudy Researching Osteoporosis iN Guys (STRONG) investigated the efficacy and safety of 150-mg monthly oral ibandronate in men with primary, idiopathic, or hypogonadism-related low bone density.

Methods: STRONG was a 1-year, placebo-controlled, randomized (2 ibandronate: 1 placebo), double-blind study that enrolled ambulatory men aged > or =30 years with baseline femoral neck (FN) bone mineral density (BMD) T-scores < or =-2.

A perspective on male osteoporosis.

Osteoporosis and fragility fracture become common with advancing age in men. The incidence of osteoporosis-related fracture is similar to myocardial infarction and exceeds that of lung and prostate carcinoma combined. These fractures cause substantial morbidity, and the mortality following hip fracture is greater in men than in women.

Slight abduction/adduction deviations in femur positioning for dual-energy X-ray absorptiometry are inconsequential.

Straight femur alignment during dual-energy X-ray absorptiometry (DXA) acquisition is assumed to help ensure accurate bone mineral density (BMD) measurement. Use of bilateral femur positioners may not result in straight femur alignment. To assess the effect of a bilateral femur positioner on DXA results, we compared a standard fixed-width bilateral femur positioner with an adjustable-width positioner that allowed for straight femur alignment.

25-hydroxyvitamin D measurement, 2009: a review for clinicians.

As clinicians are more widely appreciating the endemic nature of low vitamin D status, measurement of serum 25-hydroxyvitamin D (25(OH)D), the accepted measure of vitamin D status, has increased. Challenges to 25(OH)D measurement include the presence of 2 forms of vitamin D-ergocalciferol and cholecalciferol (vitamin D(2) and vitamin D(3), respectively)- and the hydrophobic nature of vitamin D. The current state of 25(OH)D measurement is reviewed; modest differences between methodologies persist and confound the application of a single cut point (e.

Vertebral fracture assessment: impact of instrument and reader.

Purpose: Many osteoporotic vertebral fractures are not clinically recognized but increase fracture risk. We hypothesized that a newer generation densitometer increases the number of evaluable vertebrae and vertebral fractures detected. We also explored the impact of reader experience on vertebral fracture assessment (VFA) interpretation.

Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis.

Objective: To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis.

Methods: A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis.

Results: Evidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients.

Is vitamin D the fountain of youth?

Objective: To review the role of vitamin D deficiency for both classic and "nonclassic" effects and raise the caution that association does not prove causation.

Methods: The pertinent literature regarding vitamin D and its effects on bone, muscle function, immune function, glucose tolerance, cancer risk, and development of cardiovascular disease and other conditions is reviewed. In addition, the limitations of observational studies are discussed.

Improved GI tolerability with monthly ibandronate in women previously using weekly bisphosphonates.

Objective: This subanalysis of CURRENT, an open-label, 6-month, multicenter study, assesses changes in gastrointestinal (GI) tolerability with once-monthly oral ibandronate in women who switched from once-weekly bisphosphonates and had reported GI symptoms with their previous weekly bisphosphonate regimen.

Methods: Postmenopausal women currently taking a weekly bisphosphonate switched to 150 mg monthly ibandronate. At the start of the treatment phase and after 6 months of therapy, all participants completed the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-Q), a validated instrument consisting of four domains: convenience, satisfaction, quality of life, and side effects.

Alendronate/vitamin D3 70 mg/2800 IU with and without additional 2800 IU vitamin D3 for osteoporosis: results from the 24-week extension of a 15-week randomized, controlled trial.

Although vitamin D supplementation is a fundamental part of osteoporosis treatment, many patients do not regularly take adequate amounts. A once-weekly (OW) alendronate (ALN) preparation that includes 2800 IU of vitamin D3 in a single combination tablet (ALN+D2800) is available for treating patients and ensuring intake of vitamin D that is consistent with existing guidelines. This randomized, double-blind study extension was conducted to evaluate the safety and tolerability of ALN+D2800 and ALN+D2800 plus an additional 2800 IU vitamin D3 single tablet supplement (ALN+D5600) administered for 24 weeks in men and postmenopausal women with osteoporosis previously treated OW for 15 weeks with either ALN or ALN+D2800.

Monthly ibandronate suppresses serum CTX-I within 3 days and maintains a monthly fluctuating pattern of suppression.

Unlabelled: Bone turnover markers such as serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) can be used to assess drug efficacy in osteoporosis. This study evaluated the pattern of CTX-I suppression in postmenopausal osteoporotic women receiving ibandronate. Ibandronate decreased serum CTX-I levels within 3 days of therapy initiation.

Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American women.

Low vitamin K status is associated with low BMD and increased fracture risk. Additionally, a specific menaquinone, menatetrenone (MK4), may reduce fracture risk. However, whether vitamin K plays a role in the skeletal health of North American women remains unclear.