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Management of osteoporosis with calcitriol in elderly Chinese patients: a systematic review.

Liao RX, Yu M, Jiang Y, Xia W - Clin Interv Aging (2014)

Bottom Line: It plays a role in many biological processes, especially in bone metabolism and muscle function, and is mediated by vitamin D receptors.Osteoporosis in elderly men and women is characterized by uncoupled bone remodeling, which is induced by sex hormone deficiencies, somatopause, vitamin D deficiency, reduced synthesis of D hormone, and lack of receptors or receptor affinity for D hormone in target organs.Further, calcitriol in combination with other therapeutic bone agents was shown to be well tolerated and capable of additional bone-preserving effects compared with use of calcitriol alone in areas including bone mineral density, bone turnover markers, bone pain improvement, and fracture incidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

ABSTRACT
Osteoporosis, a skeletal disorder characterized by a reduction in bone strength, is becoming a major public health problem in the People's Republic of China, with a rapid increase observed among the population. Chinese guidelines particularly recommend use of active vitamin D in managing osteoporosis. 1,25-(OH)2D3 (calcitriol) is an active vitamin D metabolite. It plays a role in many biological processes, especially in bone metabolism and muscle function, and is mediated by vitamin D receptors. Osteoporosis in elderly men and women is characterized by uncoupled bone remodeling, which is induced by sex hormone deficiencies, somatopause, vitamin D deficiency, reduced synthesis of D hormone, and lack of receptors or receptor affinity for D hormone in target organs. Reviewed here are six randomized controlled trials on calcitriol monotherapy and five on calcitriol therapy combined with other antiosteoporotic agents. Evidence from these trials shows that calcitriol monotherapy can improve bone mineral density in elderly osteoporotic Chinese patients but may be insufficient for long-term treatment. Calcitriol can also decrease bone turnover markers and bring about significant improvements in muscle strength. Further, calcitriol in combination with other therapeutic bone agents was shown to be well tolerated and capable of additional bone-preserving effects compared with use of calcitriol alone in areas including bone mineral density, bone turnover markers, bone pain improvement, and fracture incidence. Hypercalcemia and hypercalciuria, the most common side effects of calcitriol therapy, were not documented in the trials reviewed, and might have been the result of the low dosages used. One study showed that treatment with calcitriol can improve quality of life in patients with osteoporosis, although not to the same extent as bisphosphonates.

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BMD change at L2–4 and the femoral neck. Pooled estimate for the BMD change after 12 months of treatment with Caltrate D at L2–4 (A), calcitriol + Caltrate D at L2–4 (B), Caltrate D at the femoral neck (C) and calcitriol + Caltrate D at the femoral neck (D).Notes: Boxes denote estimated mean differences; bars show 95% CIs; diamond indicates pooled mean differences; and the width of the diamond indicates pooled CIs.Abbreviations: L2–4, lumbar vertebrae 2–4; CIs, confidence intervals; BMD, bone mineral density; SD, standard deviation; pre-treat, pretreatment; after-treat, after treatment; IV, inverse variance.
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f2-cia-9-515: BMD change at L2–4 and the femoral neck. Pooled estimate for the BMD change after 12 months of treatment with Caltrate D at L2–4 (A), calcitriol + Caltrate D at L2–4 (B), Caltrate D at the femoral neck (C) and calcitriol + Caltrate D at the femoral neck (D).Notes: Boxes denote estimated mean differences; bars show 95% CIs; diamond indicates pooled mean differences; and the width of the diamond indicates pooled CIs.Abbreviations: L2–4, lumbar vertebrae 2–4; CIs, confidence intervals; BMD, bone mineral density; SD, standard deviation; pre-treat, pretreatment; after-treat, after treatment; IV, inverse variance.

Mentions: The BMD measurements for the six studies before and after treatment are shown in Tables 2 and 3. Combining available data at 12 months,26–30 different BMD changes between control and trial groups were found (Figure 2) in spite of heterogeneity. In the control groups, the BMD change was not significant and tended to be negative, while in the trial groups, BMD increased significantly. Available data for absolute BMD change (Figure 3) also points to significant preservation of lumbar spine and femoral neck BMD in the calcitriol groups. Some of these studies26,27 recorded significantly higher percentage changes at the lumbar spine from baseline compared with control groups after adjusting for baseline difference. BMD change at the femoral neck ranged from being not significant26,28 to significant.27,29 Thus, calcitriol may have a beneficial effect on BMD, especially at the lumbar spine, during 12 months of treatment. In one of the reviewed studies, which had a duration of 24 months and enrolled 300 post-menopausal women between the ages of 55 and 75 years, after 24 months of treatment with calcitriol 0.25 μg/day and one Caltrate D tablet daily, BMD at the lumbar spine, trochanter, and femoral neck all decreased slightly (from 0.970±0.184 g/cm2 to 0.968±0.186 g/cm2, from 0.657±0.106 g/cm2 to 0.644±0.108 g/cm2 and from 0.724±0.083 g/cm2 to 0.722±0.102 g/cm2, respectively). We also noticed that in some studies31–33 that compared the efficacy of calcitriol monotherapy with calcitriol therapy combined with other antiosteoporotic agents, some calcitriol monotherapy groups showed no significant changes in BMD after treatment. These data suggest that using calcitriol monotherapy to treat osteoporosis in elderly patients may not provide sufficient benefits, especially as a long-term treatment.


Management of osteoporosis with calcitriol in elderly Chinese patients: a systematic review.

Liao RX, Yu M, Jiang Y, Xia W - Clin Interv Aging (2014)

BMD change at L2–4 and the femoral neck. Pooled estimate for the BMD change after 12 months of treatment with Caltrate D at L2–4 (A), calcitriol + Caltrate D at L2–4 (B), Caltrate D at the femoral neck (C) and calcitriol + Caltrate D at the femoral neck (D).Notes: Boxes denote estimated mean differences; bars show 95% CIs; diamond indicates pooled mean differences; and the width of the diamond indicates pooled CIs.Abbreviations: L2–4, lumbar vertebrae 2–4; CIs, confidence intervals; BMD, bone mineral density; SD, standard deviation; pre-treat, pretreatment; after-treat, after treatment; IV, inverse variance.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3974693&req=5

f2-cia-9-515: BMD change at L2–4 and the femoral neck. Pooled estimate for the BMD change after 12 months of treatment with Caltrate D at L2–4 (A), calcitriol + Caltrate D at L2–4 (B), Caltrate D at the femoral neck (C) and calcitriol + Caltrate D at the femoral neck (D).Notes: Boxes denote estimated mean differences; bars show 95% CIs; diamond indicates pooled mean differences; and the width of the diamond indicates pooled CIs.Abbreviations: L2–4, lumbar vertebrae 2–4; CIs, confidence intervals; BMD, bone mineral density; SD, standard deviation; pre-treat, pretreatment; after-treat, after treatment; IV, inverse variance.
Mentions: The BMD measurements for the six studies before and after treatment are shown in Tables 2 and 3. Combining available data at 12 months,26–30 different BMD changes between control and trial groups were found (Figure 2) in spite of heterogeneity. In the control groups, the BMD change was not significant and tended to be negative, while in the trial groups, BMD increased significantly. Available data for absolute BMD change (Figure 3) also points to significant preservation of lumbar spine and femoral neck BMD in the calcitriol groups. Some of these studies26,27 recorded significantly higher percentage changes at the lumbar spine from baseline compared with control groups after adjusting for baseline difference. BMD change at the femoral neck ranged from being not significant26,28 to significant.27,29 Thus, calcitriol may have a beneficial effect on BMD, especially at the lumbar spine, during 12 months of treatment. In one of the reviewed studies, which had a duration of 24 months and enrolled 300 post-menopausal women between the ages of 55 and 75 years, after 24 months of treatment with calcitriol 0.25 μg/day and one Caltrate D tablet daily, BMD at the lumbar spine, trochanter, and femoral neck all decreased slightly (from 0.970±0.184 g/cm2 to 0.968±0.186 g/cm2, from 0.657±0.106 g/cm2 to 0.644±0.108 g/cm2 and from 0.724±0.083 g/cm2 to 0.722±0.102 g/cm2, respectively). We also noticed that in some studies31–33 that compared the efficacy of calcitriol monotherapy with calcitriol therapy combined with other antiosteoporotic agents, some calcitriol monotherapy groups showed no significant changes in BMD after treatment. These data suggest that using calcitriol monotherapy to treat osteoporosis in elderly patients may not provide sufficient benefits, especially as a long-term treatment.

Bottom Line: It plays a role in many biological processes, especially in bone metabolism and muscle function, and is mediated by vitamin D receptors.Osteoporosis in elderly men and women is characterized by uncoupled bone remodeling, which is induced by sex hormone deficiencies, somatopause, vitamin D deficiency, reduced synthesis of D hormone, and lack of receptors or receptor affinity for D hormone in target organs.Further, calcitriol in combination with other therapeutic bone agents was shown to be well tolerated and capable of additional bone-preserving effects compared with use of calcitriol alone in areas including bone mineral density, bone turnover markers, bone pain improvement, and fracture incidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

ABSTRACT
Osteoporosis, a skeletal disorder characterized by a reduction in bone strength, is becoming a major public health problem in the People's Republic of China, with a rapid increase observed among the population. Chinese guidelines particularly recommend use of active vitamin D in managing osteoporosis. 1,25-(OH)2D3 (calcitriol) is an active vitamin D metabolite. It plays a role in many biological processes, especially in bone metabolism and muscle function, and is mediated by vitamin D receptors. Osteoporosis in elderly men and women is characterized by uncoupled bone remodeling, which is induced by sex hormone deficiencies, somatopause, vitamin D deficiency, reduced synthesis of D hormone, and lack of receptors or receptor affinity for D hormone in target organs. Reviewed here are six randomized controlled trials on calcitriol monotherapy and five on calcitriol therapy combined with other antiosteoporotic agents. Evidence from these trials shows that calcitriol monotherapy can improve bone mineral density in elderly osteoporotic Chinese patients but may be insufficient for long-term treatment. Calcitriol can also decrease bone turnover markers and bring about significant improvements in muscle strength. Further, calcitriol in combination with other therapeutic bone agents was shown to be well tolerated and capable of additional bone-preserving effects compared with use of calcitriol alone in areas including bone mineral density, bone turnover markers, bone pain improvement, and fracture incidence. Hypercalcemia and hypercalciuria, the most common side effects of calcitriol therapy, were not documented in the trials reviewed, and might have been the result of the low dosages used. One study showed that treatment with calcitriol can improve quality of life in patients with osteoporosis, although not to the same extent as bisphosphonates.

Show MeSH
Related in: MedlinePlus