
The aim of the review was to summarize performance of osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) Services for pay-for-performance programs.

The three areas of focus in this review was (1) screening in women 65 and older (2) providing osteoporosis management for women who have had fragility fractures, and (3) looking at fall risk assessment and documenting a care plan for people who have a risk of fall or a history of falls.

The review also examined quality improvement projects and different quality measures. Through the MIPS program, healthcare providers are required to select six quality measures. Population-based studies have suggested that achievements for process measures that are not mandated, are lower than achievement standards for those measures in which reporting is mandated.

While there have been improvements in osteoporosis DEXA screenings and other areas, in the area of osteoporosis management after a fragility fracture (which is the prime time for catching someone at high-risk for a second fracture), there were some notable performance gaps.

Only 40 percent of patients who sustained a fracture received either a bone density test or osteoporosis medication within six months of a fracture.

Plus, the review found that the rates of osteoporosis prescription medications is markedly low anywhere from 15-20 percent in patients who have sustained a fragility fracture, Dr. French said.

Patients are falling through the cracks and Dr. French explains why this may be happening.
________________

CITATION:  S French, S Choden, Gabriela Schmajuk.

 "Quality Measures and Quality Improvement Initiatives in Osteoporosis—an Update,"

. December 2019. DOI: 10.1007/s11914-019-00547-5



Videos

Today, we talk with Dr. Sarah French, a rheumatologist with the University of California at San Francisco. Dr. French recently published a review in Current Osteoporosis Reports that addresses successes and failures in quality improvement initiatives in osteoporosis. Through the MIPS program, healthcare providers are required to select six quality measures. And while they may be performing well on osteoporosis screenings, their track record on osteoporosis management isn't fairing as well. Dr. French has identified this as an area for improvement. In this interview, she explains why.

Here's How We Fail (and Succeed) in Osteoporosis Care

  Richard Furie, M.D., Brad H. Rovin, M.D., Frédéric Houssiau, M.D., Ph.D., et al. 

"Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis,"

. Sept. 17, 2020. DOI: 10.1056/NEJMoa2001180

In today’s one-on-one interview, we talk with Dr. Richard Furie who is chief of rheumatology at Northwell Health in New York. Dr. Furie is the lead investigator of a study on lupus nephritis just published in the New England Journal of Medicine. Dr. Furie and colleagues report that belimumab with standard therapy has been shown to be an effective treatment for lupus nephritis. If the treatment is approved by the U.S. Food and Drug Administration, it would be the first of its kind for this condition. In this presentation, Dr. Furie tell us more.


Belimumab With Standard Therapy Proves Beneficial in Lupus Nephritis

Low levels of osteocalcin are associated with an increased risk of diabetes in patients treated with glucocorticoids, according to a study presented on Sept. 11 at the American Society for Bone and Mineral Research (ASBMR) annual meeting which wrapped this week as a virtual meeting.

Osteocalcin is a marker of bone turnover. It is stimulated by 1,25 dihydroxy vitamin D and depends on vitamin K. 

Treatment with glucocorticoids is associated with impaired osteoblast function and decreased osteocalcin levels and also with the development of glucocorticoid-induced diabetes mellitus. However, it is not clear whether decreased osteocalcin levels in patients treated with glucocorticoids contribute to glucocorticoid-induced diabetes mellitus.

study, Pilar Peris, M.D., of the Hospital Clinic in the University of Barcelona, found that 

osteocalcin may be useful as a biomarker for identifying subjects who are at risk of developing diabetes related to glucocorticoid treatment.

Dr. Peris and colleagues analyzed whether osteocalcin levels in 127 patients on glucocorticoid treatment were associated with the presence of glucocorticoid-induced diabetes mellitus. The patients had a mean age of 62 years, 63 percent were women and they were all taking glucocorticoids (≥5mg/day,>3 months) for autoimmune diseases. 

Of the patients, 17.3 percent had glucocorticoid-induced diabetes mellitus. These patients were older than those without diabetes (70.5 versus 59.6 years, p=0.001) and had a higher body mass index (30 versus 26, p=0.002). No differences were found between patients with diabetes and patients without diabetes in glucocorticoid dose, disease duration or in the presence of vertebral fractures.

Patients with diabetes had lower levels of the bone formation markers osteocalcin (7.57 versus 11.56, p<0.001) and procollagen type I N propeptide (PINP: 21.48 versus 28.39, p=0.0048) than patients without diabetes, but similar bone alkaline phosphatase (BAP) values. Patients with diabetes also had lower levels of the bone resorption markers urinary N-terminal telopeptide (NTX: 24.91 versus 31.7, p=0.036) and serum carboxy-terminal collagen crosslinks (CTX: 0.2 versus 0.3, p=0.0016) than patients without diabetes.

The best cut-offs of each bone marker for the presence of glucocorticoid-induced diabetes mellitus were estimated as follows: <9.25ng/mL for OC, <24ng/mL for PINP, <27.5nMol/mM for NTX and <0.25ng/mL for CTX. Further analysis showed that OC <9.25ng/mL was the only bone marker related to the presence of glucocorticoid-induced diabetes mellitus (OR 6.1; CI 95% 1.87-19.89; p=0.001).

“Decreased osteocalcin levels in glucocorticoid-treated patients are associated with an increased risk of glucocorticoid-induced diabetes mellitus, a finding that was not observed with other bone turnover markers,” the authors wrote. The results further confirm “the involvement of osteocalcin in the glucose homeostasis regulation in this entity.”

 Low Serum Osteocalcin Levels are Associated with the Presence of Diabetes Mellitus in Glucocorticoid Treated Patients

. Pilar Peris. September 11. ASMBR 2020 Annual Meeting Virtual Event.

Articles

Low Osteocalcin Linked to Glucocorticoid-Induced Diabetes

Improving vitamin D status might decrease the risk of developing severe respiratory distress and death in COVID-19 cases, shows an observational study presented September 11 at the American Society for Bone and Mineral Research (ASBMR) which was held virtually this week.

“Vitamin D deficiency is common in most countries, particularly during the winter season,” study author Luigi Gennari, M.D., Ph.D., of the University of Siena in Italy, told 

 “Vitamin D supplementation and the correction of vitamin D deficiency might be of major relevance for the reduction of the clinical burden of the ongoing and future outbreaks of SARS-CoV-2 infection.”

There is an ongoing debate on whether vitamin D deficiency leads to a poorer outcome in patients with COVID-19. Epidemiology data suggest a link between COVID-19 severity and prevalence in areas of vitamin D deficiency. 

In this study, Dr. Gennari and colleagues investigated the association between 25-hydroxyvitamin-D (25OHD) levels and COVID-19 severity and mortality.

Researchers prospectively examined 103 patients (mean age 66.1 years) admitted to the hospital for symptomatic COVID-19 and 52 people with mild symptoms who did not have respiratory dysfunction. Participants with COVID-19had their vitamin D levels compared with 206 age and sex matched controls that underwent 25OH D measurement as part of a routine health visit from January to March.

At hospital admission, 25OHD levels were lower in patients with symptomatic COVID-19 (mean, 18 ng/mL) than in those with mild symptoms (30.3 ng/mL) or controls (25.4 ng/mL; p<0.0001 for both comparisons) and were inversely associated with interleukin (IL)-6 levels (p=0.004).

After hospital admission, 54 patients with symptomatic COVID-19 were admitted to an intensive care unit (ICU) due to severe acute respiratory distress syndrome. These patients had lower 25OHD (14.4 ng/mL) than patients with symptomatic COVID-19 not requiring ICU admission (22.4 ng/mL, p=0.0001) and higher IL-6 levels (49.6 versus 28.8 pg/mL, p=0.016, respectively).

Nineteen hospitalized patients died due to acute respiratory distress syndrome after an average of 19 days. The deceased patients had lower 25OHD (13.2 ng/mL) compared with those with COVID-19 who survived (19.3 ng/mL, p=0.03) and higher IL-6 levels (61.0 versus 34.9 pg/mL, p=0.02, respectively).

“Interestingly, 25OHD levels were inversely associated with either acute respiratory distress syndrome requiring ICU admission or mortality, regardless of IL-6 levels and the presence of major comorbidities,” the authors wrote. “Our data give a strong observational support to previous suggestions that reduced vitamin D levels may favor the appearance of severe respiratory dysfunction and increase the mortality risk in patients affected with COVID-19.”

Vitamin D Deficiency Is Independently Associated with 

Luigi Gennari. September 11. ASMBR 2020 Annual Meeting Virtual Event.

Low Vitamin D May Worsen COVID-19

Bisphosphonate use, especially for more than five years, is associated with an increased risk of atypical femoral fractures, but this risk falls considerably after discontinuation, according to a Nationwide Danish an analysis and review presented on September 13 at the American Society for Bone and Mineral Research (ASBMR) annual meeting which was held virtually.

One-third of atypical femoral fractures occur in individuals with no exposure to bisphosphonates, reported David Bauer, M.D., of the University of California, San Francisco.

“Concerns about atypical femoral fractures and bisphosphonates should not dissuade patients and providers from short term (three to five years) use of bisphosphonates,”Dr. Bauer said. “Drug holidays where bisphosphonates are stopped after three to five years of use should greatly reduce the risk of atypical femoral fractures and allow safe short-term use of bisphosphonates.”

Atypical femoral fractures occur infrequently, but they are a serious complication of anti-resorptive treatments. While it has been shown that prolonged bisphosphonate use is associated with higher atypical femoral fracture risk, there are few population-based studies with thorough long-term analysis of medication use and radiographic validation of atypical femoral fractures.

In this study of data from the Danish National Healthcare system, which maintains longitudinal records of medication use, fracture events and comorbidities, researchers examined the prospective relationship between bisphosphonate use and atypical femoral fractures between 2010 to 2015 in 1.9 million people aged over 50 years. Digitized pre and post-operative radiographic images from adults with subtrochanteric and femoral shaft fractures (n=4973; 96 percent of all fractures at those locations in the country) were blindly reviewedto identify 2014 ASBMR major and minor criteria. The review identified 189 atypical femoral fractures and 65 individuals with atypical femoral fractures.

One year after bisphosphonate discontinuation, the risk of atypical femoral fracture fell dramatically (RH=0.29, CI: 0.09, 0.90). Atypical femoral fracture risk was increased among patients with rheumatoid arthritis or hypertension, but was unrelated to age, gender, diabetes or other medication use.

“Atypical femoral fractures are found among individual using bisphosphonates, but the number of atypical femoral fractures is very low compared to the number of fractures prevented by the use of bisphosphonates,” Dr. Bauer said. “We need to better understand why atypical femoral fractures occur in those without bisphosphonate use.”

Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Nationwide Danish Analysis with Blinded Radiographic Review.

 Douglas Bauer. September 13. ASMBR 2020 Annual Meeting Virtual Event.

Bisphosphonate Use Associated with Increased Fracture Risk

Teriparatide, a recombinant human parathyroid hormone analog [rhPTH(1-34)] approved for women and men with osteoporosis, has been shown to renew bone tissue in patients with femoral neck fractures of the hip, according to research presented at the 

American Society for Bone and Mineral Research (ASBMR) annual meeting which was held this week.

significant effect on reducing hip fractures. 

"This study is reassuring to both patients and doctors that teriparatide has an immediate positive effect on bone formation at this, the most serious sites of osteoporosis-related fractures,” said David Dempster, Ph.D., of Columbia University in New York, who presented the results on September 12. “This is the first histological study to look at the effects of any osteoporosis drug on the human femur.”

This was a double-blind trial of 35 patients undergoing total hip replacement for osteoarthritis. Participants were randomized to receive teriparatide daily or a placebo for an average of six weeks before surgery.

In cancellous and endocortical bone tissue, remodeling-based bone formation was significantly higher in patients treated with teriparatide than in the placebo group. In the intracortical and periosteal tissue sections, no significant differences were observed in any parameter. These findings are similar to those seen with early teriparatide in the iliac crest.

“Teriparatide rapidly stimulates bone formation in the human femoral neck. Formation occurs primarily in and around existing remodeling units but there is also stimulation of modeling based formation (i.e. formation without resorption), which is a very efficient way to build bone mass,” Dr. Dempster said.

Effects of Teriparatide on Modeling-based and Remodeling-based Bone Formation in the Human Femoral Neck

. David Dempster. September 12. ASMBR 2020 Annual Meeting Virtual Event.

Teriparatide, a recombinant human parathyroid hormone analog [rhPTH(1-34)] approved for women and men with osteoporosis, has been shown to renew bone tissue in patients with femoral neck fractures of the hip, according to research presented at the American Society for Bone and Mineral Research (ASBMR) annual meeting which was held this week.

Teriparatide for Bone Formation in Hip Fractures

In postmenopausal women with osteoporosis, a single dose of zoledronate (Reclast, Novartis) maintains the increases in femoral neck and total hip bone mineral density achieved with combination teriparatide/denosumab for at least 27 months, according to a study presented at the 

American Society for Bone and Mineral Research (ASBMR) annual meeting 

“These data suggest that short-term overlapping treatment with teriparatide and denosumab followed by a single dose of zoledronic acid may be a particularly effective strategy in the long-term management of patients at high risk of osteoporotic fractures,” according to study author 

The optimal way to prevent the high-turnover bone loss caused by stopping denosumab has not been defined. The 

 reported that teriparatide combined with denosumab greatly increased bone mineral density at all anatomic sites. In the DATA-HD Extension trial, Dr. Ramchand and colleagues tested the hypothesis that a single dose of zoledronate, given 24 to 35 weeks after denosumab, could preserve these bone mineral density gains for an additional 27 months in 53 postmenopausal women with osteoporosis.

At the femoral neck and total hip, the mean 5.6 percent and 5.1 percent gains in bone mineral density achieved by month 15 were maintained both 12 and 27 months after zoledronate administration. At the spine, the mean 13.5 percent gain in bone mineral density achieved by month 15 was maintained for the first 12 months but decreased thereafter resulting in a 3 percent reduction 27 months after zoledronate administration. Still, spine bone mineral density remained 10.1 percent higher than the original DATA-HD baseline.

Further, the pattern of bone mineral density changes between months 15 and 42 were similarin participants who has received 20-µg or 40-µgof teriparatide in DATA-HD. Between months 15 and 27, femoral neck bone mineral density decreased more in patients who received zoledronate early (<26 weeks) versus those who received it late (>30 weeks) but this difference did not persist to month 42.

“A single dose of zoledronic acid 5 mg effectively maintains the large and rapid gains in hip and spine bone mineral density achieved after 15 months of overlapping treatment with teriparatide and denosumab,” Dr. Ramchand said. “Hip BMD was maintained for at least 27 months and spine BMD was fully maintained for 12 months and partially maintained 27 months after the transition.”

Meanwhile, a further follow up trial, DATA-HD Extension HR-pQCT, presented by Dr. Ramchand found that a single dose of zoledronate effectively maintained trabecular, but not cortical, volumetric bone miner density and microarchitecture at peripheral anatomic sites after treatment with combination teriparatide/denosumab.

“The increase in cortical porosity after 12 months from the transition, and the ongoing microstructural deterioration observed, would suggest more frequent re-dosing of zoledronic acid is required,” Dr. Ramchand said.

[1037] Zoledronic Acid Maintains Areal Bone Density after Denosumab Administration (DATA-HD Extension). Sabashini K. Ramchand. September 12. ASMBR 2020 Annual Meeting Virtual Event.

[1038] Effect of Zoledronic Acid on Volumetric Bone Density and Microarchitecture after Denosumab Administration (DATA-HD Extension HR-pQCT Study). Sabashini K. Ramchand. September 12. ASMBR 2020 Annual Meeting Virtual Event.

Some evidence shows the combination of teriparatide and denosumab, followed by a single dose of zoledronate, may be an effective strategy in the long-term management of high-risk fragility fractures.

Zoledronate As Booster Drug in Fight Against Osteoporosis

Spending more time in high-intensity physical activity in early life may protect against osteoporosis in later life, and men are more successful at this than women, according to a study recently published in 

“Our results from female participants indicate that moderate to vigorous activity during adolescence is more important for adult hip strength than the participant’s current participation in moderate-to-vigorous activity, which is consistent with the hypothesis that adolescence is a sensitive period for bone development,” wrote the authors, led by Ahmed Elhakeem, Ph.D., of the University of Bristol in the U.K.

Peak bone strength, which occurs in early adulthood, is considered an important marker of osteoporosis risk and 

 compose a large proportion of the disease burden of osteoporosis, modifiable early life factors that are associated with the attainment of peak hip strength need to be identified. Higher-intensity physical activity has been reported to be beneficial for bone strength, but previous studies mostly included young adolescents and they examined activity at a single point or used self-reported data.

The aim of this cohort study was to investigate the association of time spent in moderate to vigorous intensity and light intensity physical activity throughout adolescence and hip strength at age 25 years. A total 2,569 participants (62 percent female) received accelerometer assessments at age 12, 14, 16, and/or 25 years. The primary outcome was femur neck bone mineral density (BMD) at age 25 years.

In males and females, more time spent in moderate-to-vigorous intensity physical activity in adolescence was associated with greater hip BMD at age 25 years, whereas more time spent in light-intensity physical activity was not associated with BMD at age 25 years. Males spent more time in moderate to vigorous–intensity activity at each age and had greater femur neck BMD at 25 years than females.

In females, the level of moderate-to-vigorous intensity activity remained stable through early adolescence and increased at age 25 years. In males, the level of moderate to vigorous–intensity activity decreased throughout adolescence. Moreover, vigorous–intensity exercise at both the early- and mid-adolescence in males was associated with adult hip parameters, which the authors suggested may indicate that moderate to vigorous–intensity physical activity is more important in early adolescence than in later adolescence.

Meanwhile, exploratory analyses using accelerometers worn by participants at age 18 years indicated that exposure to high-magnitude gravitational force was positively associated with peak hip strength. Taken together, the results may suggest that moderate to vigorous–intensity physical activity and higher gravitational force measurements throughout early life are associated with increases in bone mass during growth.

“Higher-intensity physical activity, along with potential bursts of higher-impact activity, throughout adolescence may be important for maximizing peak hip strength during early adulthood,” the authors wrote. “Children’s involvement in moderate to vigorous–intensity physical activity may be beneficial for lasting bone health.”

In an accompanying editorial, Rodrigo Antunes Lima, Ph.D., of the University of Graz in Austria, wrote, “in our interpretation, there is one key message in this study: a higher intensity of physical activity during adolescence, especially early adolescence, plays an important role in later BMD.” He added, “Physically active adolescents are more likely to become physically active adults who are less susceptible to all-cause mortality. Thus, it is important to increase the physical activity level of the adolescent population.”

Ahmed Elhakeem, Jon Heron, Jon H. Tobias, et al.

“Physical Activity Throughout Adolescence and Peak Hip Strength in Young Adults.”

 August 17, 2020. doi:10.1001/jamanetworkopen.2020.13463

Rodrigo Antunes Lima, Fernanda Cunha Soares. 

“Physical Activity Level During Adolescence—Possible Ways to Apply the Knowledge Gathered.”

 August 17, 2020. doi:10.1001/jamanetworkopen.2020.13900

Spending more time in high-intensity physical activity in early life may protect against osteoporosis in later life, and men are more successful at this than women, according to a study recently published in JAMA Network Open.

High-Intensity Activity in Adolescence May Help Prevent Osteoporosis 

Drug therapy appears to be the first-line option for reducing fracture risk in osteoporosis, but it is not always feasible, and increasing calcium, vitamin D and protein intake may be a more practical option.

Alongside regular physical activity, a balanced nutrient intake is essential for the reduction of osteoporosis risk.

Dr. Araceli Munoz-Garach, of Virgen de las Nieves Hospital in Granada, Spain, and colleagues, discuss the association of bone health with nutrition.

Calcium and vitamin D, which form part of the bone mineral matrix as calcium phosphate, are required for bone strength. The most important sources of calcium in the diet are dairy products, fish, pulses, nuts and seeds. Pharmacological calcium supplementation could be useful when dietary sources are poorly tolerated or insufficient. A majority of vitamin D is obtained from cutaneous synthesis after sunlight exposure, with a minimal amount obtained via foods, such as oily fish, mushrooms and some fortified dairy products, but no foods can provide enough vitamin D to meet requirements.

“In elderly or postmenopausal women, vitamin D deficiency may aggravate osteoporosis,” the authors wrote. “Additionally, adequate concentrations of 25-hydroxyvitamin D (25(OH)D) are necessary for maximizing the efficacy of anti-osteoporotic drugs.”

For dairy products, the beneficial role in bone health has been established in Chinese and Caucasian girls and women, but these study results have not been replicated in other populations. Moreover, no large randomized clinical trials evaluating dairy intake over long periods of time have been undertaken. 

Other minerals that have an important role in bone health include potassium, which may reduce the acid load and, thus, calcium depletion from bones, and or magnesium, which is also necessary for calcium metabolism. In a nationwide Korean study, the highest intake of potassium was associated with greater lumbar, total hip, and femur neck bone mineral density in men older than 50 years and postmenopausal women. While no randomized trials evaluating the effect of magnesium on bone disease are available, small-size studies have associated low serum magnesium levels with osteoporosis.

Protein intake is also essential for bone health. Adequate protein intake is essential for bone matrix formation and maintenance, and it has been shown that there is no adverse effect of higher protein intake on bone. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends a daily dietary protein intake of 1.0–1.2 g/kg body weight, with at least 20–25 g of high-quality protein at each main meal.

While vitamin K is involved in bone matrix formation during mineralization, few trials exist and a clinically meaningful effect of vitamin K on bone mineral density has not been shown. Vitamin C can improve bone health due to its antioxidant properties. A recent meta-analysis supported previous findings that increasing dietary vitamin C intake could decrease the risk of hip fractures, but there is little information in clinical practice guidelines in terms of vitamin C intake. Fruit and vegetables are rich potassium and magnesium, and in vitamin C, vitamin K, folate and carotenoids.

Folate and vitamin B-12 might also influence bone by reducing homocysteine concentrations, which is linked to lower bone mineral density and a higher risk of fracture. Meanwhile, lower serum and bone zinc concentrations have been described in patients with osteoporosis. The evidence regarding the effects of omega-3 polyunsaturated fatty acids on bone metabolism is conflicting, and, as with all nutrients, further study is needed.

Dietary pattern studies are more useful than single-nutrient and food studies for revealing the effects of different nutrients alone on bone health. However, the majority of studies assessing the association between bone mineral status or fracture risk and dietary patterns had a cross-sectional design, which have influenced their results and further conclusions.

“In general, a dietary pattern with a high intake of fruit, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts and legumes has been demonstrated to have a positive effect on bone health and directly associated with a better bone mineral density and lower risk of fracture,” the authors wrote. “An adequate calcium intake seems to be recommendable for bone health, regardless of dietary preferences.”

Marina Morato-Martínez, Bricia López-Plaza, Manuel Muñoz-Torres. 

“Nutrients and Dietary Patterns Related to Osteoporosis.”

July 4, 2020. https://doi.org/10.3390/nu12071986

Drug therapy appears to be the first-line option for reducing fracture risk in osteoporosis, but it is not always feasible, and increasing calcium, vitamin D and protein intake may be a more practical option.


Calcium and Vitamin D First to Reduce Fracture Risk?

High-dose vitamin D supplementation compared with standard-dose vitamin D supplementation resulted in a greater loss of volumetric bone mineral density in women but not men, according to a study presented on Sept. 11 at the 

American Society for Bone and Mineral Research (ASBMR) annual meeting

 which is being held virtually this week.

In this Q&A, author Lauren Burt, Ph.D., a senior scientist at McCaig Institute for Bone & Joint Health, University of Calgary, highlights the findings of this three-year study. 

311 healthy males and females (55-70 years) were randomly assigned to receive vitamin D supplementation for three years at a dose of 4,000 IU, 10,000 IU per day, or 400 IU per day. After three years, females lost 1.8 percent (400), 3.8 percent (4000) and 5.5 percent (10,000) of volumetric bone mineral density, whereas males lost 0.9 percent (400), 1.3 percent(4000) and 1.9 percent(10,000) at the radius. At the tibia, losses in volumetric bone mineral density were smaller, but followed a similar trend.

What are the main takeaways from the study?

"We found vitamin D at a dose of 4,000 IU or 10,000 IU per day, compared with 400 IU per day, resulted in greater losses of volumetric bone mineral density, in females. However, in males, there was no dose-response effect of vitamin D supplementation on volumetric bone mineral density.

If you have normal bone density and adequate levels of vitamin D, there is no bone benefit in taking doses of vitamin D above the standard recommendations designed to prevent vitamin D deficiency; and that doses at or above 4000 IU/day might even be detrimental to bone, especially in females.

However, due to the exploratory post-hoc analysis, the possibility of high dose vitamin D causing harm needs further investigation."

How can the findings help clinicians and patients?

"These results are clinically relevant, as vitamin D supplementation is widely administered to postmenopausal females for osteoporosis prevention. These findings raise the possibility that in vitamin D-sufficient females, additional high dose vitamin D supplementation might have a detrimental effect on bone."

What are the limitations of the findings?

"It is important to emphasize this was an exploratory outcome from our clinical trial. We were not powered to look at the differences between sex in our primary analysis. Different results may be observed in osteoporotic or vitamin D deficient individuals. Further research is needed to determine whether high-dose vitamin D is harmful to bone, particularly for females.

​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 

For more news from the annual ASBMR meeting, visit our conference page.

Lauren A. Burt,Emma O. Billington, Marianne S. Rose, et al. 

Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial.

 August 27, 2019. doi:10.1001/jama.2019.11889

High-dose Vitamin D Supplementation Affects Bone Density Differently in Females than Males.

. August 10, 2020. https://doi.org/10.1002/jbmr.4152

High-dose vitamin D supplementation compared with standard-dose vitamin D supplementation resulted in a greater loss of volumetric bone mineral density in women but not men, according to study data presented at the American Society for Bone and Mineral Research (ASBMR) annual meeting which is being held virtually.


