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Archives of Osteoporosis

, 13:114 | Cite as

Calcitriol treatment in patients with low vitamin D levels

  • Refik TanakolEmail author
  • Nurdan Gül
  • Ayşe Kubat Üzüm
  • Ferihan Aral
Original Article
  • 101 Downloads

Abstract

Summary

The aim of the the study is to compare the effects of cholecalciferol and calcitriol on bone mineral metabolism in women with vitamin D deficiency. Calcitriol was associated with a significant increase in bone mineral density at the lumbar spine in patients with low vitamin D levels.

Purpose/introduction

Active vitamin D analogs may have larger impact in decreasing bone loss and fracture rate compared to cholecalciferol in osteoporosis. However, their effects in the treatment of vitamin D deficiency compared to cholecalciferol are not clear. The aim of the present study is to compare the effects of cholecalciferol and calcitriol on bone mineral metabolism and bone mineral density in pre- and postmenopausal women with vitamin D deficiency.

Methods

This was a 6-month prospective, open-label, controlled clinical trial. Eligible 120 participants were pre- and postmenopausal women diagnosed with vitamin D deficiency. Forty-three subjects (group 1) received 1000 IU of cholecalciferol and 1 g of calcium daily. The other 77 subjects (group 2) received 0.5 μg calcitriol in addition to 400 IU of cholecalciferol and 1 g of calcium daily.

Results

Oral vitamin D supplementation did not increase bone mineral density after 6 months of intervention in group 1. On the other hand, bone mineral density at the lumbar spine increased from 0.809 ± 0.172 to 0.848 ± 0.161 g/cm2 in group 2 patients (p < 0.017 vs baseline).

Conclusions

Oral daily calcitriol was associated with a significant increase in bone mineral density at the lumbar spine in patients with low vitamin D, elevated PTH, and osteoporosis.

Keywords

Calcitriol Vitamin D deficiency Osteoporosis Cholecalciferol Bone mineral density 

Notes

Funding information

Refik Tanakol declares no competing financial interest and certifies that no funding has been received for the conduct of this study and/or preparation of this manuscript.

Nurdan Gül declares no competing financial interest and certifies that no funding has been received for the conduct of this study and/or preparation of this manuscript.

Ayşe Kubat Üzüm declares no competing financial interest and certifies that no funding has been received for the conduct of this study and/or preparation of this manuscript.

Ferihan Aral declares no competing financial interest and certifies that no funding has been received for the conduct of this study and/or preparation of this manuscript.

Compliance with ethical standards

This study was conducted in full compliance with the principles of the Declaration of Helsinki. Ethical approval was obtained from Ethics Committee of Istanbul Faculty of Medicine (Dean’s approval and Ethics Committee ref. No. 467 70954-700-2017-551) [12]. Written informed consent for participation was obtained from participants or, where participants are children, a parent or guardian.

Conflict of interest

None.

References

  1. 1.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  2. 2.
    Li X, Liao L, Yan X, Huang G, Lin J, Lei M, Wang X, Zhou Z (2009) Protective effects of 1-α-hydroxyvitamin D3 on residual beta-cell function in adult-onset latent autoimmune diabetes (LADA). Diabetes Metab Res Rev 25:411–416CrossRefGoogle Scholar
  3. 3.
    Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 13(3):257–264CrossRefGoogle Scholar
  4. 4.
    Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis. JAMA 282(14):1344–1352CrossRefGoogle Scholar
  5. 5.
    Chesnut CH, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, Felsenberg D, Huss H, Gilbride J, Schimmer RC, Delmas PD, and for the oral ibandronate osteoporosis vertebral fracture trial in North America and Europe (Bone) (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19(8):1241–1249CrossRefGoogle Scholar
  6. 6.
    Meunier PJ, Slosman DO, Delmas PD, Sebert JL, Brandi ML, Albanese C, Lorenc R, Pors-Nielsen S, De Vernejoul MC, Roces A, Reginster JY (2002) Strontium ranelate: dose dependent effects in established postmenopausal vertebral osteoporosis- a 2-year randomized placebo controlled trial. J Clin Endocrinol Metab 87:2060–2066PubMedGoogle Scholar
  7. 7.
    Lau KH, Baylink DJ (1999) Vitamin D therapy of osteoporosis: plain vitamin D therapy versus active vitamin D analog (D-hormone) therapy. Calcif Tissue Int 65:295–306CrossRefGoogle Scholar
  8. 8.
    Bischoff-Ferrari HA, Borchers M, Gudat F, Dürmüller U, Stahelin HB, Dick W (2004) Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res 19:265–269CrossRefGoogle Scholar
  9. 9.
    Papadimitropoulos E, Wells G, Shea B (2002) Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23:560–569CrossRefGoogle Scholar
  10. 10.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716CrossRefGoogle Scholar
  11. 11.
    Genant HK, Jergas M, Palermo L et al (1996) Coomparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996CrossRefGoogle Scholar
  12. 12.
    World Medical Association Declaration of Helsinki (2000) Ethical principles for medical research involving human subjects. JAMA 284:3043–3045CrossRefGoogle Scholar
  13. 13.
    Zhang H, Huang Q, Gu J, HU W, Liu Y, Hu Y, Zhang Z (2012) Comparison of the effects of cholecalciferol and calcitriol on calcium metabolism and bone turnover in Chinese postmenopausal women with vitamin D insufficiency. Acta Pharmacol Sin 33(4):490–495CrossRefGoogle Scholar
  14. 14.
    Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257–2264CrossRefGoogle Scholar
  15. 15.
    Binkley N, Novotny R, Krueger D, Kawahara TN, Daida YG, Gemar D, Lensmeyer GL, Hollis BW, Drezner MK (2007) J. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 92:2130–2135CrossRefGoogle Scholar
  16. 16.
    Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer J, Petruschek RA, Chen E, dePapp AE (2005) Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90: 3215–24Google Scholar
  17. 17.
    Seeman E, Delmas PD (2006) Bone quality-the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261CrossRefGoogle Scholar
  18. 18.
    Ringe JD, Schacht E (2004) Prevention and therapy of osteoporosis: the roles of plain vitamin D and alfacalcidol. Rheumatol Int 24:189–197CrossRefGoogle Scholar
  19. 19.
    Tsukamoto Y, Watanabe T, Nakagami T, Morishita K (2003) Effect of treatment with oral calcitriol on calcium metabolism and fasting serum 25OH-or 1,25(OH)2 vitamin D level in Japanese postmenopausal women. Endocr J 50:681–687CrossRefGoogle Scholar
  20. 20.
    Gurlek A, Pittelkow MR, Kumar R (2002) Modulation of growth factor/cytokine synthesis and signalling by 1alpha,25dihydroxyvitamin D3: implications in cell growth and differentiation. Endocr Rev 23:763–786CrossRefGoogle Scholar
  21. 21.
    Sibata T, Shira-Ishi A, Sato T, Masaki T, Sasaki A, Masuda Y et al (2002) Vitamin D hormone inhibits osteoclastogenesis in vivo by decreasing the pool of osteoclast precursors in bone marrow. J Bone Miner Res 17:622–629CrossRefGoogle Scholar
  22. 22.
    Dobnig H (2011) A review of the health consequences of the vitamin D deficiency pandemic. J Neurol Sci 311(1–2):15–18CrossRefGoogle Scholar
  23. 23.
    Clements MR, Davies M, Hayes ME, Hickey CD, Lumb GA, Mawer EB et al (1992) The role of 1,25-dihydroxyvitamin D in the mechanism of acquired vitamin D deficiency. Clin Endocrinol. Oxf 37:17–27Google Scholar
  24. 24.
    Halloran BP, Bikle DD, Levens MJ, Castro ME, Globus RK, Holton E (1986) Chronic 1,25-dihydroxyvitamin D3 administration in the rat reduces the serum conentration of 25-hydroxyvitamin D by increasing metabolic clearance rate. J Clin Invest 78:622–628CrossRefGoogle Scholar
  25. 25.
    Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ (2004) A randomised controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: the Nottingham neck of femur (NoNOF) study. Age Ageing 33:45–51CrossRefGoogle Scholar
  26. 26.
    Richy F, Ethgen O, Bruyere O, Reginster J-Y (2004) Efficacy of alfacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int 15(4):301–310CrossRefGoogle Scholar
  27. 27.
    Gallagher JC (2004) The effects of calcitriol on falls and fractures and physical performance tests. J Steroid Biochem Mol Biol 89-90:497–501CrossRefGoogle Scholar
  28. 28.
    Schacht E, Richy F, Reginster J-Y (2005) The therapeutic effects of alfacalcidiol on bone strength, muscle metabolism and prevention of falls and fractures. J Musculoskelet Neuronal Interact 5(3):273–284PubMedGoogle Scholar
  29. 29.
    Richy F, Dukas L, Schacht E (2008) Differential effects of D-hormone analogus and native vitamin D on the risk of falls: a comparative meta-analysis. Calcif Tissue Int 82:102–107CrossRefGoogle Scholar
  30. 30.
    Shane E, Adesso V, Namerow PB, McMahon DJ, Lo SH, Staron RB, Zucker M, Pardi S, Maybaum S, Mancini D (2004) Alendronate or calcitriol and prevention of bone loss after cardiac transplantation. N Engl J Med 350(8):767–776CrossRefGoogle Scholar
  31. 31.
    Frediani B, Allegri A, Bisohno S, Marcolongo R (1998) Effects combined treatment with calcitriol plus alendronate on bone mass and bone turnover in postmenopausal osteoporosis. Two years of continuous treatment. Clin Drug Invest 14:235–244CrossRefGoogle Scholar
  32. 32.
    Hermann M, Widmann T, Colaianni G, Colucci S, Zallone A, Hermann W (2005) Increased osteoclastic activity in the presence of increased homocysteine concentrations. Clin Chem 51:2348–2353CrossRefGoogle Scholar
  33. 33.
    Hubmacher D, Sabatier L, Annis DS, Mosher DF (2011) Reinhardt DP. Homocysteine modifies structural and functional properties of fibronectin and interferes with the fibronectin-fibrillin-1 interaction. Biochemistry 50:5322–5332CrossRefGoogle Scholar
  34. 34.
    Calo L, Castrignano R, Davis PA, Carraro G, Pagnin E, Giannini S, Semplicini A, D’Angelo AA (2000) Role of insulin-like growth factor-I in primary osteoporosis: a correlative study. J Endocrinol Investig 23:223–227CrossRefGoogle Scholar
  35. 35.
    Boonen S, Mohan S, Dequeker J, Aerssens J, Vanderschueren D, Verbeke G, Broos P, Bouillon R, Baylink DJ (1999) Down-regulation of the serum stimulatory components of the insulin-like growth factor (IGF) system (IGF-I, IGF-II, IGF binding protein (BP)-3 and IGFBP-5) in age related (type II) femoral neck osteoporosis. J Bone Miner Res 14:2150–2158CrossRefGoogle Scholar
  36. 36.
    Li J, Jih D, Fu S, Mei G, Zhou J, Lei L, Yu B, Wang G (2013) Insulin -like growth factor binding protein-3 modulates osteoblast differentiation via interaction with vitamin D receptor. Biochem Biophys Res Commun 436:632–637CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Refik Tanakol
    • 1
    Email author
  • Nurdan Gül
    • 1
  • Ayşe Kubat Üzüm
    • 1
  • Ferihan Aral
    • 1
  1. 1.Department of Endocrinology and MetabolismIstanbul University, Istanbul Faculty of MedicineIstanbulTurkey

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