The additive effect of vitamin K supplementation and bisphosphonate on fracture risk in post-menopausal osteoporosis: a randomised placebo controlled trial

This study assessed whether vitamin K, given with oral bisphosphonate, calcium and/or vitamin D has an additive effect on fracture risk in post-menopausal women with osteoporosis. No difference in bone density or bone turnover was observed although vitamin K1 supplementation led to a modest effect on parameters of hip geometry.

PURPOSE

Some clinical studies have suggested that vitamin K prevents bone loss and may improve fracture risk. The aim was to assess whether vitamin K supplementation has an additive effect on bone mineral density (BMD), hip geometry and bone turnover markers (BTMs) in post-menopausal women with osteoporosis (PMO) and sub-optimum vitamin K status receiving bisphosphonate, calcium and/or vitamin D treatment.

METHODS

We conducted a trial in 105 women aged 68.7[12.3] years with PMO and serum vitamin K1 ≤ 0.4 µg/L. They were randomised to 3 treatment arms; vitamin K1 (1 mg/day) arm, vitamin K2 arm (MK-4; 45 mg/day) or placebo for 18 months. They were on oral bisphosphonate and calcium and/or vitamin D. We measured BMD by DXA, hip geometry parameters using hip structural analysis (HSA) software and BTMs. Vitamin K1 or MK-4 supplementation was each compared to placebo. Intention to treat (ITT) and per protocol (PP) analyses were performed.

RESULTS

Changes in BMD at the total hip, femoral neck and lumbar spine and BTMs; CTX and P1NP did not differ significantly following either K1 or MK-4 supplementation compared to placebo. Following PP analysis and correction for covariates, there were significant differences in some of the HSA parameters at the intertrochanter (IT) and femoral shaft (FS): IT endocortical diameter (ED) (% change placebo:1.5 [4.1], K1 arm: -1.02 [5.07], p = 0.04), FS subperiosteal/outer diameter (OD) (placebo: 1.78 [5.3], K1 arm: 0.46 [2.23] p = 0.04), FS cross sectional area (CSA) (placebo:1.47 [4.09],K1 arm: -1.02[5.07], p = 0.03).

CONCLUSION

The addition of vitamin K1 to oral bisphosphonate with calcium and/or vitamin D treatment in PMO has a modest effect on parameters of hip geometry. Further confirmatory studies are needed.

TRIAL REGISTRATION

The study was registered at Clinicaltrial.gov:NCT01232647.

Evaluation of panoramic Radiographs as a Screening Tool of Osteoporosis in Post Menopausal Women: A Cross Sectional Study

BACKGROUND

Indian women, especially those from low-income groups consume diets that are deficient of calcium, proteins and micronutrients. Hence, they are prone to suffer from osteoporotic hip fractures at a much earlier age than western women. To detect early signs of osteoporosis, it is ideal to perform Bone Mineral Density testing of all post-menopausal women who are at risk.

AIM

(i) To assess and compare the relative efficacy, ease of application and measurement of the various mandibular cortical indices which were obtained on the panoramic radiographs with bone densitometry data of post-menopausal women. and (ii) To evaluate the effectiveness of these measurements in the identification of cases of osteoporosis/osteopaenia.

METHOD

A cross sectional sample which consisted of 40 randomly selected post menopausal women who were aged 40-69 years was subjected to dental panoramic radiography. Mental index, panoramic mandibular index, gonion index, mandibular cortical index and antegonial index were measured on each radiograph. The data were expressed as mean and standard deviation. Analysis of variance with post-hoc Tukey's test was performed to determine group differences in mandibular measurements.

RESULTS

Based on the bone densitometry results, the sample was classified into normal (n=9), osteopaenic (n=15) and osteoporotic (n=16) groups. Statistically significant differences were found for mean Mental index (p=0.000), mean Panoramic Mandibular Index (p=0.007) and mean Gonial Index (p=0.000). The sensitivity (100%) and specificity (88.88%) of MCI showed good results.

CONCLUSION

Dentists who use orthopantomographs may play a vital role in screening patients with osteoporosis, mainly among post menopausal women.

Postmenopausal osteoporosis: Our experience

INTRODUCTION

There is very little published literature about experience with osteoporosis treatment from our country.

MATERIALS AND METHODS

It is a retrospective analysis of first 50 patients enrolled in our clinic for osteoporosis. Postmenopausal women with T score of less than -2.5 or history suggestive fragility fracture with supportive bone mineral density (BMD) were included. Patients having hypercalcemia, abnormal renal function, myeloma and on long-term steroids were also excluded.

RESULTS

Nearly 34% subjects were below the age of 60 years, 47% of subjects were between 60 and 70 years, whereas 18% were above 70 years. Nearly 6% had family history of osteoporosis s or history of osteoporotic fractures. Nearly 20% subjects had fracture prior to starting of any treatment. A total of 86% (40/46) had evidence of Vitamin D (VD) deficiency. Nearly 80% of patients were treated with bisphosphonates, 12% were treated with injectable bisphosphonates, and 8% were treated with teriperatide. Nearly 16% patients had duration of more than 5 years of experience with bisphosphonates. Follow up BMD was available in 25 subjects. BMD had improved significantly in 68% of subjects. In 24% the BMD was stable (the change was less than least significant change (LSC)). In 8% BMD had shown a significant decline while being on treatment.

CONCLUSION

Postmenopausal osteoporosis occurs in relatively younger women in our country. Majority of them are VD deficient. Oral bisphosphonates is the most common used drug; it is fairly well tolerated and effective.