Vitamin D, calcium with alendronate may prevent steroid induced bone loss in ITP patients

Vitamin D plus calcium along with alendronate prevents steroid-induced bone loss in ITP patients, finds a new study.

The administration of vitamin D plus calcium along with alendronate (ALN) increases bone mineral density (BMD) in immunologic thrombocytopenic purpura (ITP) patients taking steroid treatment compared with Caltrate D (CalD) treatment alone. The findings of the study are reported in the journal Experimental and Therapeutic Medicine.

The treatment also elevated the BMD at three skeletal sites and inhibited urinary calcium excretion and the activity of bone resorption markers in patients with ITP.

Studies in the past have found that increased vitamin D intake may preserve or increase bone mineral density (BMD) if added to calcium especially in older persons.

Immunologic thrombocytopenic purpura is a hematologic disorder characterized by low levels of platelets -- the blood cells that prevent bleeding. This results from accelerated platelet consumption, shortened platelet survival and impaired platelet production.

Bone loss is a prominent complication in patients with ITP on steroid treatment. Anti‑osteoporotic medications are provided as a therapeutic strategy for the prevention of one deterioration in ITP patients. The skeletal protective effect of alendronate (ALN) in ITP patients has been rarely reported.

Zong‑Xin Zhang, Huzhou Central Hospital, Huzhou, Zhejiang, China, and colleagues determined whether ALN reduces bone loss in ITP patients.

The study involved 40 ITP patients with steroid treatment. The patients were randomized into a placebo group [n=20; caltrate D (CalD)] and an ALN (10 mg/day) + CalD group (n=20). They received CalD or CalD + ALN treatment for 9 months.

The primary outcomes were bone mineral density (BMD) in the lumbar vertebrae (L1-L4), femoral neck and total hip, as well as bone metabolism markers.

Key findings of the study include:

• BMD of the lumbar vertebrae (L1-L4), femoral neck and total hip was significantly increased after ALN + CalD treatment for at 6 and 9 months compared with the baseline.


• Compared with CalD treatment alone, CalD combined with ALN significantly elevated the BMD at the three skeletal sites at 9 months.


• Compared with the baseline levels or CalD treatment alone, ALN together with CalD treatment markedly reduced urinary Ca excretion and the serum levels of the bone resorption markers tartrate-resistant acid phosphatase 5b and C-terminal telopeptides of type 1 collagen, at 9 months.

"Our study demonstrated that treatment with alendronate (ALN) together with CalD significantly elevated the BMD at three skeletal sites and inhibited urinary Ca excretion and the activity of bone resorption markers in patients with ITP," concluded the authors.

To read the complete study follow the link https://doi.org/10.3892/etm.2019.7694