Outcome of bisphosphonate, vitamin D and calcium therapy in patients with established osteoporosis based on FRAX model

Introduction: WHO defined Osteoporosis as a bone mineral density (BMD) of 2.5 SD or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry. FRAX is a computer-based algorithm developed by the World Health Organization Collaborating Centre for Metabolic Bone Diseases and first released in 2008. The output of FRAX is the 10-year probability of a major osteoporotic fracture and the 10-year probability of hip fracture. Objective: To assess the outcome of combined bisphosphonate, vitamin D and calcium therapy in patients with established osteoporosis at the end of 15 months, to assess the relationship between vit D, Calcium and osteoporosis with reference to existing FRAX model and to analyze whether any correlation exists between serum Vitamin D levels and BMD as established by DEXA Scan. Materials and Methods: A prospective observational study was performed in 128 patients who underwent screening with Vitamin D levels and DEXA scan to confirm osteoporosis. DEXA scan was employed primarily to establish a case as osteoporosis according to the definition. These patients were started on treatment with combined Bisphosphonates standard dosage of alendronate 70 mgs once per week with standard instructions for 15 months, Vitamin D was administered to patients with established hypovitaminosis as standard therapy with oral sachet of 60,000 I.U administered with milk for 8 weeks. Calcium supplements were given as calcium carbonate 1G per day for 15 months. The final assessment was done by the end of 15 months by analyzing the results of BMD and Vitamin D levels to look for any improvement. Results: In our study of 128 patients we found that, there was statistically significant improvement in mean ± SD Vit D and FRAX hip score at end of study while comparing with pretreatment scores. There was a strong positive correlation between FRAX score hip and FRAX score osteoporosis. Conclusion: The combination of vitamin D3, bisphosphonate and calcium improves bone mineral density and reduces the risk of hip and other osteoporotic fractures at the end of 15 months based on FRAX model.