[Sequential calcitriol-calcitonin in the therapy of osteoporosis]

Different therapeutic regimens have been proposed by Authors in the treatment of involutional (and particularly postmenopausal) osteoporosis. Following the up to date concepts on bone remodelling, an ADFR (Activate, Depress, Free, Repeat) trial was performed in 20 females affected by involutional osteoporosis. They were treated with Calcitriol 2 mcg/d for 7 days, followed by a 21 days period of 100 U/d Salmon Calcitonin + 1 g/d Calcitonin, followed by a 2-month period of Calcium alone. The cycles were repeated for 1 year and the results of densitometric examinations (radial mineral content evaluated by single photon absorptiometer, and vertebral mineral content evaluated by dual photon absorptiometer) and of biochemical markers (Ca++, P, osteocalcin, alkaline phosphatase, hydroxyproline) controlled every 3 months, were compared with those obtained in a group of patients treated only with Salmon Calcitonin and in a group treated with Calcium for 1 year. After two therapeutical cycles radial bone mineral density significantly increased; vertebral bone density also increased but not significantly. The effects were more evident in comparison to calcitonin alone treatment. A significant reduction in serum osteocalcin was documented. At the end of the therapy no further improvement was registered. This suggests that some variations and adaptation of therapeutic strategy are needed to achieve a more important and substantial improvement of bone conditions.