Vitamin D analogs for the treatment of secondary hyperparathyroidism

Calcitriol controls parathyroid gland (PTG) growth and suppresses the synthesis and secretion of PTH. However, because of its potent effects on intestinal calcium and phosphorus absorption and bone mobilization, calcitriol treatment can induce hypercalcemia and hyperphosphatemia often precluding its use at therapeutic doses. In the past decade, several vitamin D analogs have been developed. These analogs retain the action on the PTG while having less effect on calcium and phosphorus. Most of these analogs for the treatment of secondary hyperparathyroidism (SH) have a modification on the side chain of calcitriol. In the USA, two vitamin D analogs 19-nor 1,25(OH)(2)D(2) and 1 alpha(OH)D(2) are currently used for the treatment of SH. Studies in animals demonstrated that 19-nor-1,25(OH)(2)D(2) is less calcemic and phosphatemic than 1 alpha(OH)D(2). The lower Ca x P product in 19-nor-1,25(OH)(2)D(2)-treated rats may be an important consideration in patient therapy. Further studies in patients are necessary to define these differences.