J Bone Metab.  2014 Aug;21(3):217-222. 10.11005/jbm.2014.21.3.217.

Increase in the Serum Parathyroid Hormone Level During a Bisphosphonate Drug Holiday

• Song YK
• Kim JM
• Park SJ
• Lee SK

• KMID: 2286292
• DOI: http://doi.org/10.11005/jbm.2014.21.3.217

Abstract

After discontinuation of bisphosphonate therapy, an antiresorptive effect and antifracture protection persist for an undefined period. Patients are encouraged to continue calcium and vitamin D supplementation, during a bisphosphonate drug holiday. However, assessment of adequate calcium intake during the bisphosphonate drug holiday is difficult. Therefore, we measured the serum intact parathyroid hormone (PTH) level as a surrogate marker. A premenopausal woman discontinued bisphosphonate therapy, after 7.5 years of treatment. Two months later, blood calcium and phosphorus levels were normal, serum 25-hydroxyvitamin D level was 31.3 ng/mL, but serum PTH level had increased to 94.9 pg/mL. The elemental calcium supplement dose was increased to 600 mg/day, with no change in the cholecalciferol dose (400 IU). Her serum PTH levels decreased to 49.1 after 4 months and 32.9 pg/mL after 5 months. The serum PTH level may be helpful in assessing adequate calcium intake during a bisphosphonate drug holiday.

Keyword

Bisphosphonate; Calcium; Parathyroid hormone; Vitamin D

MeSH Terms

Biomarkers
Calcium
Cholecalciferol
Female
Holidays*
Humans
Parathyroid Hormone*
Phosphorus
Vitamin D
Calcium
Cholecalciferol
Parathyroid Hormone
Phosphorus
Vitamin D

Figure

• 

  Fig. 1 Serum parathyroid hormone levels during the bisphosphonate drug holiday. This scheme shows the serum parathyroid hormone levels of the patient who was taking elemental calcium supplements, 2 months, 6 months, and 7 months after the start of the bisphosphonate drug holiday. 25-(OH)D, 25-hydroxyvitamin D; PTH, intact parathyroid hormone.

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