Maximizing the efficacy of bisphosphonate therapy
Bisphosphonate therapy can't hold up without calcium ... Yet 85 to 90% of women are likely to have low calcium intake1,2
Bisphosphonates require adequate levels of calcium + vitamin D to work effectively:
To ensure maximum benefit, adequate calcium must be present in the bone to allow for osteoblasts to deposit new bone material.3 In fact, the pivotal studies underpinning the approval of bisphosphonates required adequate calcium intake, and supplementation was part of the methodology.1
Case report shows bisphosphonate therapy alone will not lead to sufficient reduction of bone catabolism.2
During bisphosphonate clinical trials adequate calcium intake was a consideration. In the vast majority of these studies supplementation with calcium and vitamin D3 was a methodology requirement; with a large number using OS-CAL as the preferred study supplement.1,3
Bisphosphonate prescriptions and patient information contain statements recommending calcium supplementation if dietary intake is insufficient.1
However, the majority of your patients are likely to not consume enough calcium and be vitamin D deficient:
Low calcium intake is extremely common:
- 85% of postmenopausal women are estimated to not consume enough calcium4
- 90% of adult women aged 20 plus5
- 73% of adult men aged 20 plus5
Vitamin D deficiency is common in >50% of postmenopausal women treated for osteoporosis have inadequate vitamin D levels6
Making sure your patients are getting enough calcium will be critical to the therapeutic success of bisphosphonate treatment.
Don't forget the OS-CAL — twice a day, every day with meals
“In order for these drugs to provide the maximum effectiveness in the treatment of osteoporosis, it is vital that calcium supplements be taken concurrently and consistently.”
Journal of Women's Health — Sunyecz, 20051
Bisphosphonates are the most common prescription for osteoporosis
A number of medications are used to help manage osteoporosis and/or osteopenia.3 For example:
Anti-resorptive medications such as: Bisphosphonates, Calcitonin, HT, Selective Estrogen Reuptake Modulators (SERMs)
Bone-forming medications such as: Parathyroid hormone (Forteo)
Because of their proven efficacy, bisphosphonate medications (such as alendronate, ibandronate, zoledronic acid, and risedronate) are increasingly used as the first choice prescription for osteoporosis and/or osteopenia.3
“These drugs [osteoporosis treatments] are viewed by patients and physicians as a major breakthrough in the management of osteoporosis. Unfortunately, this view has led many to ignore the importance of concurrent calcium supplementation...”
Journal of Women's Health — Sunyecz, 20053
Persistence with bisphosphonate therapy is poor7
Osteoporosis is a chronic condition and the effectiveness of bisphosphonate therapies depends on patient persistence in taking their medication as directed. However, persistence and compliance can be compromised because dosing is complicated and often inconvenient.
Bisphosphonates can't work without adequate calcium levels, but, more important, they won't work if patients choose to discontinue therapy with or without their physician's knowledge.7
Calcium supplements and bisphosphonates should not be taken together1,3
Bisphosphonates have an affinity for many foods, drugs, and supplements, especially calcium salts. Therefore adequate calcium intake can be difficult to achieve in bisphosphonate users. If calcium supplements and bisphosphonates are taken too close together, the bisphosphonate will bind with the calcium salt and decrease or negate the effects of both.3
Thus, it is critical for the physician to stress the necessity for calcium supplementation with bisphosphonate use while also educating the patient on how to take both the calcium and drug supplement properly.1,3
It is important to note that calcium carbonate supplements like OS-CAL, unlike calcium citrate products, direct the patient to always take them with meals. This may help reduce the potential for bisphosphonate and supplement interaction.