[Vitamin D supply and the effect of short term calcium and vitamin D supplementation in postmenopausal women with osteoporosis or osteopenia]


AUGUST 20, 2003

Ca&Bone - 2003;6(04)

[INTRODUCTION - The effect of short-term calcium and vitamin D supplementation by a clinical nutriment on bone formation and resorption was studied in postmenopausal women with normal or decreased calcidiol serum levels. PATIENTS AND METHODS - Ninety-one postmenopausal women (age, 60-75 years) were enrolled in the study to investigate the effect of 1120 mg calcium and 208 IU vitamin D in a complex composition (Fortimel®, Nutricia) on bone turnover after 4 weeks of treatment. All women suffered from osteopenia or osteoporosis detected by bone densitometry. Serum parathyroid hormone levels and bone turnover markers (serum β-CrossLaps, osteocalcin and alkaline phosphatase) were determined before and after the treatment. Moreover, calcidiol serum level was also measured at the beginning of the study to assess vitamin D supply. A questionnaire was used to assess gastrointestinal side effects and urinary calcium/creatinine ratio was calculated to estimate the risk of kidney stone development. RESULTS - In the entire patient group the mean serum level of β-CrossLaps was elevated (526.97±29.26 pg/ml) before the study and decreased during the treatment (485.58±28.27 pg/ml, p=0.03).The mean serum level of osteocalcin (28.58±1.37 vs. 27.03±1.36 ng/ml, p=0.025) and serum alkaline phosphatase activity (200.46±8.72 vs. 186.94±11.64 U/l, p=0.033) both decreased.The serum 25-OH vitamin D3 was below 30 ng/ml in 20 patients before the treatment, suggesting vitamin D deficiency.A correlation (r=0.508, p<0.001) between the decrease of bone formation and the decrease of bone resorption was found only in patients with normal serum 25-OH vitamin D3 concentration (>30 ng/ml). However, bone turnover did not decrease in patients with calcidiol deficiency. Urinary calcium/creatinine ratio remained unchanged during the treatment, but two patients suffered from constipation and one of them had diarrhea due to the calcium supplementation. CONCLUSIONS - Calcium and vitamin D supplementation in a complex clinical nutriment proved to be effective in decreasing bone turnover in postmenopausal women with good vitamin D supply, even after a short treatment period of 4 weeks. However, this treatment was ineffective in patients with vitamin D deficiency suggesting the importance of serum calcidiol measurement before calcium supplementation. Calcium in complex with other nutrients such as citrate did not increase the risk of renal stone formation in the short run, and only caused gastrointestinal problems in a tiny fraction of patients.]


  1. Semmelweis Egyetem, Általános Orvostudományi Kar, I. Számú Belgyógyászati Klinika, Budapest
  2. Ferencvárosi Önkormányzat Regionális Osteoporosis Központ, Budapest
  3. Heves Megyei Önkormányzat Markhot Ferenc Kórház-Rendelõintézet, Eger
  4. Budavári Önkormányzat Egészségügyi Szolgálat, Budapest
  5. Belváros, Lipótváros Egészségügyi Szolgálat, Budapest
  6. Petz Aladár Megyei Kórház, Gyõr
  7. Komárom-Esztergom Megyei Önkormányzat Szent Borbála Kórház, Tatabánya
  8. Pécsi Tudományegyetem, Általános Orvostudományi Kar, Ortopédiai Klinika, Pécs
  9. Fejér Megyei Szent György Kórház, Székesfehérvár
  10. Szent András Állami Reumatológia és Rehabilitációs Kórház, Hévíz
  11. Flór Ferenc Kórház, Reumatológiai Osztály, Kistarcsa
  12. Jávorszki Ödön Kórház, Vác



Further articles in this publication


[The effects of thyroid hormones on bone]


[The effects of thyroid hormones on bone tissue are of fundamental importance.They are required for skeletal development and later for normal bone metabolism.Their action is dose-dependent and also depends on the degree of differentiation of the target tissue. In childhood, thyroid hypofunction manifests itself in growth retardation, whereas hyperfunction will accelerate bone maturation.The exact mechanism of action of thyroid hormones on bone in later years is poorly understood, and their clinical relevance on the risk of bone fracture, the most important complication, is also unclear. In adults with hypothyroidism, bone mineral density (BMD) remains unchanged or even becomes increased, but the risk of fractures is elevated. In hyperthyroidism the bone turnover is increased, which may lead to a decrease in BMD and a higher risk of fracture. However, the results are inconsistent for endogenous subclinical hyperthyroidism, where BMD may also decrease and fractures may occur more frequently.Treatment of hypothyroidism may temporarily result in increased fragility but this phenomenon seems to be only transient. During L-T4 replacement therapy the TSH level should be kept in the normal range, while with suppression, it should be set to the lower end of the normal range. During treatment of hyperthyroidism BMD temporarily increases and the risk of fractures decreases.The most effective way of preventing osteoporosis and bone fractures in all cases is the early recognition and treatment of thyroid diseases.The presence of other osteoporosis risk factors should always be considered. In some cases adjuvant therapy may be necessary to stop bone loss.]


[Quality of life and osteoporosis]



[Renal stone formation after parathyroidectomy in patients with primary hyperparathyroidism]

BERCZI Csaba, BALÁZS György, LUKÁCS Géza, TÓTH Csaba

[INTRODUCTION - The incidence of renal stone formation was studied in patients with primary hyperparathyroidism after parathyroidectomy. PATIENTS AND METHODS - Ninety-two patients operated on for hyperparathyroidism were included in the study. In Group 1 the patients (n=44) had kidney stones before parathyroidectomy. Patients with no history of nephrolithiasis (n=48) before the operation were assigned to Group 2. After the operation the occurrence of renal stones was assessed for both groups.The presence of any association between the recurrence of renal stones and various clinical parameters was analysed. RESULTS - The serum concentration of Ca and parathormone decreased to the normal range in both groups after the operation. Stone formation was observed in nine cases in five patients during follow-up. All five patients belonged to Group 1.Thirty-three % of these recurrent stones were diagnosed within the first year and 89% within 5 years. Statistical analysis did not reveal any significant association between recurrent stone formation and gender, age, preoperative serum levels of Ca and parathormone or the histology of parathyroid glands. CONCLUSION - The incidence of recurrent renal stones after successful parathyroidectomy significantly decreased in patients with primary hyperparathyroidism.]




[Assessment of quality of life in postmenopausal women with osteoporosis - A comparative study on the Hungarian adaptations of EuroQoL and Nottingham Health Profile]

PÉNTEK Márta, LICKER-FÓRIS Edit, LOVAS Kornélia, KALÓ Zoltán, TÓTH Miklós, TULASSAY Zsolt, RATKÓ István, GENTI György

[INTRODUCTION - After a brief introduction to the definition of quality of life and the importance of its measurement, two questionnaires, the EQ-5D and the Nottingham Health Profile are presented. PATIENTS AND METHODS - Fifty postmenopausal women with osteoporosis were included in the two-year prospective study to assess quality of life by the two generic questionnaires. Correlations were sought between the results of the EQ-5D and the Nottingham Health Profile, as well as between bone fractures and changes in quality of life.The validated Hungarian version of the Nottingham Health Profile was applied for the first time in postmenopausal osteoporosis. RESULTS - With the treatments applied, quality of life dimensions did not change significantly during the follow-up period and no significant correlation was found between the incidence of bone fractures and changes in quality of life.The pain, physical mobility, emotional reactions and energy dimensions of the validated Hungarian Nottingham Health Profile and its derivated index showed significant correlations with those of the EQ-5D. CONCLUSION -The validated Hungarian version of the Nottingham Health Profile quality of life questionnaire is a useful and applicable measurement tool in postmenopausal osteoporosis which correlates with the EQ-5D health state measure.]

All articles in the issue

Related contents


[Evaluation of quality of life following treatment with calcitonin nasal spray in patients with osteoporosis: preliminary results of the MERLIN study]


[INTRODUCTION - MERLIN (Management of Osteoporosis in Elderly with Calcitonin) is an open-label, multicenter, prospective, follow-up study conducted in Hungary, part of which is to assess the impact of treatment with Miacalcic, - an intranasal salmon calcitonin, on the quality of life (QoL) among patients with osteoporosis. In this paper we report the preliminary results of the MERLIN study. PATIENTS - The study initially involved 1949 senior patients (aged >65 years) to whom calcitonin was prescribed for osteoporosis according to the application instructions. Patients presented at outpatient clinics and consisted of two groups; they were either newly diagnosed or they had been receiving a therapy for osteoporosis other than calcitonin. METHODS - This latter group discontinued their previous treatment and all patients received 200 IU intranasal salmon calcitonin (SCT) once daily for three months. Patient and physician questionnaires were used to collect information on the patients' QoL (EQ-5D VAS) and their general well-being at baseline and at follow-up visits at week 4 and week 12. RESULTS - Calcitonin use was associated with improvements in all EQ-5D domains and component scores as well as in VAS. Patients with previously known osteoporosis who, switched to calcitonin therapy achieved better results (0,046 QALY), than the newly diagnosed patients (0,0405 QALY). CONCLUSIONS - We conclude that intranasal SCT 200 IU daily is safe and effective in improving QoL of both, male and female patients with low bone mineral density.The conclusions that can be drawn from this study are limited due to the lack of a control group and to the unblinded design. Further placebo-controlled studies are needed to confirm these results. Nevertheless, our study was the first in Hungary to evaluate the quality of life impact of an osteoporosis treatment, and hopefully it will be followed by more such studies directed to other osteoporosis treatments.]


[Bone metabolism and body mass index in postmenopausal women]

TÁRCZY Csaba, TOLDY Erzsébet, SZERB János, VARGA László

[INTRODUCTION - In addition to several other causes constitutional factors play an important role in the development of osteoporosis.Various aspects of bone metabolism were examined to explain the differences in bone density between women with low and high body mass index (BMI). PATIENTS AND METHOD - One hundred and ninetytwo postmenopausal women were included in the study. Bone density was measured by forearm densitometry.To assess bone formation, serum osteocalcin levels were measured, while the rate of bone absorption was estimated from C-terminal telopeptide levels of collagen type I measured in urine and blood. RESULTS - The prevalence of osteoporosis was higher in women with low BMI than in those with normal or higher BMI. Bone metabolism - both formation and absorption - was increased in both groups, however, in women with low BMI this increase was more pronounced and bone metabolism tended to be shifted to absorption compared to patients with normal or higher BMI. CONCLUSION - Postmenopausal lean women have accelerated bone metabolism compared to obese women. This fact and the shift to absorption may be the main reasons for the higher frequency of osteoporosis found by densitometry in women with low BMI than in those with higher BMI.]


[Bone mineral density and diabetes mellitus - First results]


[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]

LAM Extra for General Practicioners



[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]


[„HOPE for people with fracture”: Results of the HOPE (Hungarian Osteoporosis Project for Elderly) study]


[We conducted a multicentre, prospective, single cross-sectional, 12-month, open-label study for the assessment of treatment satisfaction using TSQM (Treatment Satisfaction Questionnaire for Medication) for zoledronic acid therapy used in patients with osteoporosis, who suffered minor traumatic fractures. PATIENTS AND METHODS - In total 1736 patients from 94 centers completed the study and filled in the TSQM questionnaire at both visit 1 and visit 2. TSQM is suitable for measuring the patient’s satisfaction with a treatment, by evaluating side-effects, efficacy and convenience of the treatment and the patient’s overall satisfaction rated on a scale of 0 to 100. RESULTS - Patients included in the study previously received a mean of 1.58 other therapies for osteoporosis and their case history included a mean of 1.24 fractures. This real-life study demonstrated that even one year of zoledronate treatment significantly (p<0.0001) improved the satisfaction of patients regarding efficacy (a mean change from a score of 56.15 to 70.89) as well as the occurrence of side-effects on a TSQM score. Regarding the convenience of treatment, the mean score increased from 62.96 to 79.34 (p<0.0001), whereas the overall treatment satisfaction changed from 59.3 to 75.48 by visit 2 (p<0.0001). CONCLUSIONS - Our study demonstrated beneficial TSQM results associated with zoledronic acid treatment, which is a basic requirement for appropriate adherence as well. ]