[Vitamin D therapy in renal osteodystrophy]

In Japan, three oral preparations (calcitriol, alfacalcidol and falecalcitriol) and two intravenous preparations (calcitriol and maxacalcitol) are now available for the vitamin D(3) therapy in renal osteodystrophy. In general, oral therapy is indicated for mild cases of secondary hyperparathyroidism (intact PTH<300 pg/mL) to maintain adequate level of serum PTH except "calcitriol oral pulse therapy" for moderate to severe cases. Recently, intravenous therapy has been introduced to treat more severe cases by using the advantage of rapid clearance of these metabolites. In order to use these preparations safely, adequate level of both serum intact PTH (150-300 pg/mL) and Ca/P product (<55) should be maintained to prevent from adynamic bone and vascular calcification.