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Diphosphonates and phosphate homoeostasis in man
E V McCloskey1, A J Yates, R E Gray
1Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School, U.K.
Clinical Science (London, England : 1979)
|June 1, 1988
Summary
Three diphosphonates affect phosphate balance differently in Paget's disease patients. Etidronate caused sustained increases, while others led to temporary rises and calcium drops, impacting parathyroid hormone levels.
Area of Science:
- Bone Metabolism and Endocrinology
- Pharmacology and Therapeutics
Background:
- Paget's disease of bone is a chronic disorder characterized by abnormal bone remodeling.
- Diphosphonates are commonly used to treat Paget's disease by inhibiting osteoclast activity.
- Understanding the effects of different diphosphonates on phosphate and calcium homeostasis is crucial for patient management.
Purpose of the Study:
- To investigate the impact of three intravenous diphosphonates (etidronate, clodronate, aminohexane diphosphonate) on phosphate homeostasis.
- To compare the effects of these diphosphonates in patients with Paget's disease and hypoparathyroidism.
Main Methods:
- A study involving 30 patients with Paget's disease and 3 patients with hypoparathyroidism.
- Administration of intravenous etidronate, clodronate, or aminohexane diphosphonate.
- Monitoring of serum phosphate, calcium, and renal tubular reabsorption of phosphate.
Main Results:
- All diphosphonates increased serum phosphate and renal tubular reabsorption of phosphate in Paget's disease patients.
- Etidronate produced the most marked and sustained effects.
- Clodronate and aminohexane diphosphonate caused transient increases followed by decreases in phosphate and calcium, with increased parathyroid hormone levels.
Conclusions:
- Diphosphonates enhance renal tubular reabsorption of phosphate.
- The phosphaturic effect is attenuated by secondary hyperparathyroidism induced by some diphosphonates.
- Differential effects on calcium and phosphate homeostasis necessitate careful consideration of diphosphonate choice.