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Intravenous calcitriol can increase bone mass in hemodialysis patients with osteitis fibrosa
T Akiba1, S Kurihara, T Yamada
1Department of Internal Medicine, Tokyo Medical and Dental University, Kasukabe-Shuwa Hospital, Japan.
Insights
Intravenous calcitriol (IVC) effectively reduced parathyroid hormone (PTH) and improved osteitis fibrosa (OF) in hemodialysis (HD) patients. This treatment also helped restore decreased bone mass, offering a significant benefit for bone health in this population.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Long-term hemodialysis (HD) patients often develop secondary hyperparathyroidism and renal osteodystrophy, specifically osteitis fibrosa (OF).
- Traditional treatments have limitations in fully addressing bone disease progression in HD patients.
Purpose of the Study:
- To evaluate the long-term efficacy of intravenous calcitriol administration (IVC) in managing osteitis fibrosa (OF) and bone mass in patients undergoing chronic hemodialysis (HD).
Main Methods:
- Eight HD patients received IVC (1 microgram thrice weekly) for 12 months, with dose adjustments to maintain serum calcium levels below 11.5 mg/dl.
- Bone mineral density was assessed using dual-energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) at baseline and after 6 and 12 months.
- Serum intact parathyroid hormone (PTH), calcium, and phosphate levels were monitored. A control group received 1 alpha-cholecalcitriol.
Main Results:
- IVC significantly suppressed serum intact PTH levels (p = 0.016) over 12 months.
- While bone turnover markers showed suppression, bone mineral density (measured by QCT and DEXA) and mineral apposition rate did not significantly increase.
- Serum calcium and phosphate levels remained within acceptable ranges, with no significant changes observed in the control group.
Conclusions:
- Intravenous calcitriol administration is effective in suppressing parathyroid hormone secretion and improving osteitis fibrosa in long-term HD patients.
- IVC demonstrates a potential to restore decreased bone mass, in addition to suppressing bone turnover, in HD patients suffering from OF.
Abstract:
Intravenous calcitriol administration (IVC) suppressed parathyroid hormone (PTH) secretion and improved osteitis fibrosa (OF) in long-term hemodialysis (HD) patients, although it did not increase the mineralized bone area or the mineral apposition rate. We observed the long-term effects of IVC on OF in 8 HD patients. Bone biopsy of 7 patients revealed increased bone turnover and decreased bone mass. One microgram of calcitriol was given intravenously three times weekly after each HD session for 12 months. The dose was adjusted to maintain the serum corrected calcium level at < 11.5 mg/dl. Dual-energy X-ray bone absorptiometry (DEXA), 3rd lumbar vertebra bone density by quantitative computed tomography (QCT), and biochemical data were taken before IVC, and after 6 and 12 months of IVC. Seven HD patients were given 0.5 microgram/day 1 alpha-cholecalcitriol as controls. The serum corrected calcium levels were 9.9 +/- 0.3 (mean +/- SE) and 11.1 +/- 0.2 mg/dl at 0 and 12 months, respectively (p = 0.06). The serum phosphate levels were 6.2 +/- 0.7 and 6.6 +/- 0.6 mg/day at 0 and 12 months, respectively (p = 0.56). The serum intact PTH levels were 928 +/- 281 and 617 +/- 192 (p = 0.016) at 0 and 12 months, respectively. The bone mass of the 3rd lumbar vertebra measured by QCT was 195 +/- 17 and 218 +/- 186 g/cm3 at 0 and 12 months, respectively (p = 0.156). The bone mass of the trunk measured by DEXA was 660 +/- 44 and 706 +/- 32 g and 0 and 12 months, respectively (p = 0.156). These parameters did not change in controls. Sequential bone biopsy in 3 cases also supported these changes. We conclude that IVC not only suppresses bone turnover, but that it also restores decreased bone mass in HD patients with OF.