Calcitriol treatment in metabolic bone disease of prematurity with elevated parathyroid hormone: A preliminary study

Area of Science:

• Pediatric Endocrinology
• Neonatology
• Nutritional Biochemistry

Background:

• Metabolic bone disease of prematurity (MBD) with secondary hyperparathyroidism is a common complication in preterm infants.
• Elevated parathyroid hormone (PTH) levels indicate significant bone disease activity.

Purpose of the Study:

• To evaluate the effectiveness of calcitriol in managing MBD and secondary hyperparathyroidism in preterm infants.
• To assess the impact of calcitriol on key biochemical markers of bone metabolism.

Main Methods:

• A retrospective chart review of 32 preterm infants with MBD and PTH >100 pg/ml.
• Analysis of serum intact PTH, calcium, phosphorus, alkaline phosphatase, urine calcium/creatinine, and tubular reabsorption of phosphate before and after calcitriol treatment.

Main Results:

• Calcitriol treatment led to a significant decrease in PTH levels (220 to 25 pg/ml, p < 0.001).
• Biochemical markers improved, with increased serum calcium (9.9 to 10.3 mg/dl, p < 0.001), phosphorus (4.3 to 5.4 mg/dl, p = 0.001), and TRP (81% to 91.5%, p = 0.03).
• Alkaline phosphatase showed no significant change (p = 0.12); hypercalcemia/hypercalciuria occurred in 3 infants and resolved with dose adjustment.

Conclusions:

• Calcitriol treatment effectively improves MBD markers in preterm infants with secondary hyperparathyroidism.
• The observed improvements suggest calcitriol is a viable treatment option with a favorable safety profile in this population.