Weight-Bearing Physical Activity Influences the Effect of Vitamin D on Bone Turnover Markers in Patients with Intellectual Disability

Oral bisphosphonates for osteoporosis in adult males with intellectual disabilities

“…Furthermore, while the numbers are small (only 9 male individuals), and more research is certainly needed before any firm conclusions can be made, weekly/ monthly oral bisphosphonates appear to be effective in increasing BMD in ambulatory adult males with intellectual disability. In addition, consistent with previous reports (Adami et al, 2009;Bischoff-Ferrari et al, 2004;Carmel et al, 2012;Mosali et al, 2014) with intellectual disability who were never treated with bisphosphonates (Frighi et al, 2019;May & Winters, 2019).…”

“…This may indicate a need for a higher serum level of 25-hydroxy vitamin D, more weight-bearing physical activity, or both. Additionally, since we did not have a control group treated with vitamin D alone, we cannot rule out the possibility that the improved BMD observed in our study was more the result of treatment with vitamin D rather than bisphosphonate, since recent reports have demonstrated suppressive effects of vitamin D on PTH and CTX in ambulatory males with intellectual disability who were never treated with bisphosphonates (Frighi et al, 2019;May & Winters, 2019).…”

“…One recent report demonstrated suppressive effects of vitamin D on PTH and CTX in ambulatory males with intellectual disability who were never treated with bisphosphonates (May & Winters, 2019).…”

“…There was a slightly positive trend between duration of treatment (years) and per cent increase in average bone mineral density that was not statistically significant, and there were trends for lower PTH and CTX with higher serum vitamin D levels that did not achieve statistical significance. One recent report demonstrated suppressive effects of vitamin D on PTH and CTX in ambulatory males with intellectual disability who were never treated with bisphosphonates (May & Winters, 2019).…”

“…In addition, consistent with previous reports (Adami et al, 2009; Bischoff‐Ferrari et al, 2004; Carmel et al, 2012; Mosali et al, 2014), our results also indicate that in normal‐weight‐bearing adults with intellectual disability, a serum level of 25 (OH)D up to 40–50 ng/ml is associated with improved BMD and bisphosphonate efficacy and therefore lowered fracture risk. However, other reports (Burt et al, 2019; May & Winters, 2019) create concern that higher serum levels of 25 (OH)D, above 50 ng/ml, may lead to increased osteoclast activity and loss of BMD, especially if the patient is older and/or has less‐weight‐bearing physical activity. While all the individuals in this current study were ambulatory, the levels of weight‐bearing physical activity were not measured.…”