The problem of low levels of vitamin D and osteoporosis: use of combination therapy with alendronic acid and colecalciferol (vitamin D3).

Osteoporosis and fragility fractures are common in the elderly population and represent a large public health burden. Non-pharmacological recommendations for the management of osteoporosis include modification of lifestyle behaviours, increased weight-bearing exercise and consumption - through dietary or supplement sources - of adequate amounts of calcium and vitamin D. Although current guidelines include recommendations on calcium and vitamin D intake, patients frequently do not take sufficient amounts, even when supplements are provided free of charge. Vitamin D is essential for mineral metabolism, and low levels are associated with impaired skeletal metabolism and neuromuscular function. Nutritional sources of vitamin D are limited, and supplementation is usually necessary. A high prevalence of low vitamin D levels has been reported in a number of populations worldwide, including women being treated for osteoporosis and those with fragility fractures. At present, bisphosphonates are the most commonly prescribed pharmacological treatments for osteoporosis, and alendronic acid is the most frequently prescribed bisphosphonate. A nitrogen-containing bisphosphonate, alendronic acid has demonstrated anti-fracture efficacy at vertebral and non-vertebral skeletal sites, including the hip, in addition to long-term safety and efficacy. Weekly administration of alendronic acid takes advantage of the pharmacokinetics of the drug and osteoclast biology to optimise treatment, and may improve patient adherence. Combining alendronic acid 70mg and colecalciferol (vitamin D(3)) 2800 IU in a single, once-weekly tablet has the advantage of combining the proven efficacy of an established bisphosphonate, alendronic acid, with the amount of vitamin D currently recommended for osteoporosis management.