title: Between-meal risedronate does not alter bone turnover in nursing home residents.
abstract: OBJECTIVE
  To assess the effect of between-meal weekly risedronate and daily calcium 630 mg and vitamin D 400 IU on bone turnover markers.
  
  
  METHODS
  Randomized,double-blind,placebo-controlled trial.
  
  
  METHODS
  Skilled nursing home (NH).
  
  
  METHODS
  Sixty skilled-NH residents (46 men, 14 women), mean age+/-standard deviation of 76+/-6, were randomized to receive risedronate 30 mg (n=31) or matching placebo (n=29) once weekly for 12 weeks. All received 315 mg calcium with 200 IU vitamin D twice daily.
  
  
  METHODS
  Bone-specific alkaline phosphatase (BSAP), N-telopeptide of type 1 collagen (NTx), 25-hydroxyvitamin D (25OHD), and parathyroid hormone were measured at baseline and 6 and 12 weeks.
  
  
  RESULTS
  Risedronate reduced BSAP significantly more than placebo (P<.05) at 6 weeks but not at 12 weeks; no treatment effect on serum NTx was observed. Defining hypovitaminosis D as a serum 25OHD concentration below 32 ng/mL, 50 of 53 (94%) study participants were low at baseline (mean 25OHD 19 ng/mL). Vitamin D levels remained insufficient in 74% of participants after 12 weeks.
  
  
  CONCLUSIONS
  In this NH population, weekly risedronate administered using a between-meal dosing schedule reduced serum BSAP at 6 weeks of treatment; this effect was not observed at 12 weeks. The overall lack of change in bone turnover markers suggests that this risedronate dose and schedule would not be expected to increase bone density or reduce fracture risk in this population. Hypovitaminosis D was common and not reliably corrected by 400 IU of vitamin D daily. Despite an extremely high osteoporotic fracture risk in NH residents, additional study is required to determine under which conditions pharmacological treatment is efficacious in this population and define approaches that assure vitamin D repletion.
authors.affiliation: Osteoporosis Clinical Center and Research Program, University of Wisconsin, 2870 University Avenue, Madison, WI 53705, USA. sabina.agrawal@med.va.gov
authors.forename: Sabina
authors.initials: S
authors.lastname: Agrawal
authors.forename: Diane C
authors.initials: DC
authors.lastname: Krueger
authors.forename: Jean A
authors.initials: JA
authors.lastname: Engelke
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Nest
authors.forename: Peggy F
authors.initials: PF
authors.lastname: Krause
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Drinka
authors.forename: Neil C
authors.initials: NC
authors.lastname: Binkley
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000008:administration & dosage; D024042:Collagen Type I / Q000097:blood; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010455:Peptides / Q000097:blood; D000068296:Risedronic Acid; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D000068296:Risedronic Acid; D012968:Etidronic Acid; D002118:Calcium