The additive effect of vitamin K supplementation and bisphosphonate on fracture risk in post-menopausal osteoporosis: a randomised placebo controlled trial

Arch Osteoporos. 2023 Jun 20;18(1):83. doi: 10.1007/s11657-023-01288-w.

Abstract

This study assessed whether vitamin K, given with oral bisphosphonate, calcium and/or vitamin D has an additive effect on fracture risk in post-menopausal women with osteoporosis. No difference in bone density or bone turnover was observed although vitamin K1 supplementation led to a modest effect on parameters of hip geometry.

Purpose: Some clinical studies have suggested that vitamin K prevents bone loss and may improve fracture risk. The aim was to assess whether vitamin K supplementation has an additive effect on bone mineral density (BMD), hip geometry and bone turnover markers (BTMs) in post-menopausal women with osteoporosis (PMO) and sub-optimum vitamin K status receiving bisphosphonate, calcium and/or vitamin D treatment.

Methods: We conducted a trial in 105 women aged 68.7[12.3] years with PMO and serum vitamin K1 ≤ 0.4 µg/L. They were randomised to 3 treatment arms; vitamin K1 (1 mg/day) arm, vitamin K2 arm (MK-4; 45 mg/day) or placebo for 18 months. They were on oral bisphosphonate and calcium and/or vitamin D. We measured BMD by DXA, hip geometry parameters using hip structural analysis (HSA) software and BTMs. Vitamin K1 or MK-4 supplementation was each compared to placebo. Intention to treat (ITT) and per protocol (PP) analyses were performed.

Results: Changes in BMD at the total hip, femoral neck and lumbar spine and BTMs; CTX and P1NP did not differ significantly following either K1 or MK-4 supplementation compared to placebo. Following PP analysis and correction for covariates, there were significant differences in some of the HSA parameters at the intertrochanter (IT) and femoral shaft (FS): IT endocortical diameter (ED) (% change placebo:1.5 [4.1], K1 arm: -1.02 [5.07], p = 0.04), FS subperiosteal/outer diameter (OD) (placebo: 1.78 [5.3], K1 arm: 0.46 [2.23] p = 0.04), FS cross sectional area (CSA) (placebo:1.47 [4.09],K1 arm: -1.02[5.07], p = 0.03).

Conclusion: The addition of vitamin K1 to oral bisphosphonate with calcium and/or vitamin D treatment in PMO has a modest effect on parameters of hip geometry. Further confirmatory studies are needed.

Trial registration: The study was registered at Clinicaltrial.gov:NCT01232647.

Keywords: Bisphosphonate; Hip geometry; Post menopausal osteoporosis; Vitamin K.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Density
  • Calcium / therapeutic use
  • Calcium, Dietary / therapeutic use
  • Dietary Supplements
  • Diphosphonates / therapeutic use
  • Female
  • Femur Neck
  • Fractures, Bone* / drug therapy
  • Fractures, Bone* / prevention & control
  • Humans
  • Osteoporosis, Postmenopausal* / drug therapy
  • Osteoporosis, Postmenopausal* / prevention & control
  • Vitamin D / therapeutic use
  • Vitamin K / pharmacology
  • Vitamin K / therapeutic use
  • Vitamin K 1 / pharmacology
  • Vitamin K 1 / therapeutic use
  • Vitamins / therapeutic use

Substances

  • Vitamin K
  • Diphosphonates
  • Calcium
  • Vitamins
  • Vitamin D
  • Vitamin K 1
  • Calcium, Dietary

Associated data

  • ClinicalTrials.gov/NCT01232647