Osteoporosis International

, Volume 24, Issue 1, pp 349–354 | Cite as

The impact of dietary calcium intake and vitamin D status on the effects of zoledronate

  • S. Bourke
  • M. J. Bolland
  • A. Grey
  • A. M. Horne
  • D. J. Wattie
  • S. Wong
  • G. D. Gamble
  • I. R Reid
Original Article



We investigated whether baseline dietary calcium intake or vitamin D status modified the effects of zoledronate. Neither variable influenced the effect of zoledronate on bone mineral density, bone turnover, or risk of acute phase reaction, suggesting that co-administration of calcium and vitamin D supplements with zoledronate may not always be necessary.


Calcium and vitamin D supplements are often co-administered with bisphosphonates, but it is unclear whether they are necessary for therapeutic efficacy or minimizing side effects of bisphosphonates. We investigated whether baseline dietary calcium intake or vitamin D status modified the effect of zoledronate on bone mineral density (BMD) or bone turnover at 1 year, or the risk of acute phase reactions (APR).


Data were pooled from two trials of zoledronate in postmenopausal women without vitamin D deficiency in which calcium and vitamin D were not routinely administered. The cohort (zoledronate n = 154, placebo n = 68) was divided into subgroups by baseline dietary calcium intake (<800 vs. ≥800 mg/day) and vitamin D status [25-hydroxyvitamin D (25OHD) <50 vs. ≥50 nmol/L, and <75 nmol/L vs. ≥75 nmol/L] and treatment × subgroup interactions tested.


There were 52, 86, and 36 % of the zoledronate group and 64, 94, and 46 % of the placebo group that had dietary calcium intake ≥800 mg/day, 25OHD ≥50 nmol/L, and 25OHD ≥75 nmol/L, respectively. There were no significant interactions between treatment and either baseline dietary calcium or baseline vitamin D status for lumbar spine BMD, total hip BMD, the bone turnover markers P1NP and β-CTx, or the risk of an APR. There was also no three-way interaction between baseline dietary calcium intake, baseline vitamin D status, and treatment for any of these variables.


Baseline dietary calcium intake and vitamin D status did not alter the effects of zoledronate, suggesting that co-administration of calcium and vitamin D with zoledronate may not be necessary for individuals not at risk of marked vitamin D deficiency.


Acute phase reaction Bone mineral density Dietary calcium intake Vitamin D Zoledronate 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • S. Bourke
    • 1
  • M. J. Bolland
    • 2
  • A. Grey
    • 2
  • A. M. Horne
    • 2
  • D. J. Wattie
    • 2
  • S. Wong
    • 2
  • G. D. Gamble
    • 2
  • I. R Reid
    • 2
  1. 1.Department of RheumatologyAuckland City HospitalAucklandNew Zealand
  2. 2.Bone and Joint Research Group, Department of MedicineUniversity of AucklandAucklandNew Zealand

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