Listed in Issue 228


KALYAN and COLLEAGUES, (1)Institutes of Immunology (S.K., D.K.) and Human Nutrition and Food Science (P.H.,  T.E., G.R.), Christian-Albrechts University Kiel, D-24105 Kiel, Germany;  Children's Hospital of Datteln (P.N.), University of Witten-Herdecke, D-45711  Datteln, Germany; and Department of Pathology and Laboratory Medicine (H.C.F.C.),  University of British Columbia, Vancouver, British Columbia, Canada V6T 2B5 assessed the coenzyme Q10 and  antioxidant status in relation to N-BP exposure in women with postmenopausal osteoporosis.


Nitrogen-bisphosphonates (N-BPs) are the most widely used drugs for bone fragility disorders. Long-term or high-dose N-BP use is associated with unusual serious side effects such as osteonecrosis of the jaw, musculoskeletal pain, and atypical fractures of long bones. It has escaped notice that the pathway N-BPs block is central for the endogenous synthesis of coenzyme Q10, an integral enzyme of the mitochondrial respiratory chain and an important lipid-soluble antioxidant. Our objective was to assess the coenzyme Q10 and antioxidant status in relation to N-BP exposure in women with postmenopausal osteoporosis.


Seventy-one postmenopausal women (age, 73.5 ± 5.5 y) with osteoporosis and no other malignancy were included in this cross-sectional study. Seventeen were treatment naive, 27 were on oral N-BP, and 27 were on i.v. N-BP.


Vitamin E γ-tocopherol levels (μmol/mL) were significantly reduced in N-BP users [oral, H(2) = 18.5, P = .02; i.v., H(2) = 25.2, P < .001; mean rank comparisons after Kruskal-Wallis test). Length of time (days) of N-BP exposure, but not age, was inversely associated with the coenzyme Q10/cholesterol ratio (μmol/mol) (β = -0.27; P = .025), which was particularly low for those on i.v. N-BP (mean difference = -35.0 ± 16.9; 95% confidence interval, -65.2 to -4.9; P = .02).


The degree of N-BP exposure appears related to compromised coenzyme Q10 status and vitamin E γ-tocopherol levels in postmenopausal women with osteoporosis. This phenomenon may link to certain adverse N-BP-associated effects. Confirmation of this would suggest that therapeutic supplementation could prevent or reverse certain complications of long-term N-BP therapy for at-risk individuals.


Kalyan S(1), Huebbe P, Esatbeyoglu T, Niklowitz P, Côté HC, Rimbach G, Kabelitz  D. Nitrogen-bisphosphonate therapy is linked to compromised coenzyme Q10 and vitamin  E status in postmenopausal women. J Clin Endocrinol Metab. 99(4):1307-13. Apr 2014. doi: 10.1210/jc.2013-3648. Epub  Jan 13 2014.     


The results of the above study suggested that as a result of the primary prescribed drug treatment - Nitrogen-bisphosphonates (N-BPs) - for bone fragility / osteoporosis there were compromised levels of coeymzyme Q10 and vitamin E γ-tocopherol. The authors recommend therapeutic supplementation to prevent or reverse complications from long-term N-BP therapy if these results are confirmed.

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