Discussion
mineralisation
BLIND, OSTEOPOROSIS, MINERALISATION
The purpose of this RCT was to determine whether treatment with bisphosphonates plus calcium and/or vitamin D combined with vitamin K, in post-menopausal women with serum vitamin KThe effect of vitamin K supplementation on BMD has yielded mixed results as shown by a meta-analysis of 22 trials of vitamin KIt has been suggested that vitamin K can affect other parameters of bone quality including bone turnover, mineralisation and collagen status. However previous studies of vitamin KIt has been postulated that vitamin K may have an effect on other parameters of bone strength including bone microarchitecture, geometry and strength, independently of BMD [At the FS, we observed a significant reduction in the sub-periosteal diameter (OD) and cross sectional area (CSA) in the vitamin KWe did not find any significant changes with MK-4 in any of the HSA parameters although MK-4 is thought to have specific functions on bone cells other than γ-carboxylation of VKDPs [The strength of our study is the design which was a double blind randomised controlled trial of post-menopausal women with osteoporosis. The participants had good compliance with the vitamin K supplements. Participants were seen frequently during the study and engaged with the trial. However, there were several limitations including the small size, short duration (18 months) as it may take longer for changes in BMD and/or the geometric/mechanical parameters to be seen, particularly at cortical rich sites in patients established on bisphosphonates. Not all patients had a low serum vitamin KIn conclusion, we investigated whether the addition of vitamin K