RESEARCH - Alfacalcidol versus plain vitamin D in the treament of steroid/inflammation-induced osteoporosis

[Guest guest]

Alfacalcidol Versus Plain Vitamin D in the Treatment of

Glucocorticoid/Inflammation-Induced Osteoporosis

JOHANN D. RINGE, HERBERT FABER, PARVIS FAHRAMAND, and ERICH SCHACHT

ABSTRACT.

Treatment with plain vitamin D is a nutritional substitute, while the

application of alfacalcidol is an active hormonal therapy. Due to strong

feedback regulation, plain vitamin D is not activated in the kidney in

vitamin-replete patients, while alfacalcidol, having been hydroxylated at

position 1, bypasses regulation and increases available amounts of active

D-hormone in different target tissues. Nevertheless, a majority of

physicians still prescribe plain vitamin D plus calcium as a first-step

prevention or even as therapy for glucocorticoid (GC) induced osteoporosis.

This article summarizes results of our previous study comparing the

therapeutic efficacy of the D-hormone analog alfacalcidol to plain vitamin D

in patients with established GC induced osteoporosis with or without

vertebral fracture. Patients taking longterm GC therapy were included as

well-matched pairs to receive randomly either 1 µg alfacalcidol plus 500 mg

calcium per day (group A, n = 103) or 1000 IU vitamin D3 plus 500 mg calcium

(group B, n = 101). The mean bone mineral density (BMD) values at baseline

for the 2 groups for alfacalcidol and vitamin D3, respectively, were: lumbar

spine T score –3.26 and –3.25; femoral neck –2.81 and –2.84. Rates of

prevalent vertebral and nonvertebral fractures were not different between

groups. In the 3 year study we observed in the alfacalcidol group as

compared with the plain vitamin D group, respectively: a 3 year median

percentage increase of BMD at the lumbar spine of 2.4% versus –0.8% (p <

0.0001); a median increase at the femoral neck of 1.2% versus 0.8% (p <

0.006). Likewise observed in the alfacalcidol as compared to the vitamin D

group, respectively: a 3 year rate of patients with ≥1 new vertebral

fracture of 9.7% versus 24.8% (risk reduction: 0.61; 95% CI 0.24 to 0.81; p

= 0.005); a 3 year rate of patients with ≥1 new nonvertebral fracture of 15%

versus 25% (risk reduction: 0.41; 95% CI –0.06 to 0.68; p = 0.081); a 3 year

rate of patients with ≥1 new fracture of any kind of 19.4% versus 40.6%

(risk reduction: 0.52; 95% CI 0.25 to 0.71; p = 0.001). In accordance with

the observed fracture rates, the alfacalcidol group showed a substantially

larger decrease in back pain than the plain vitamin D group (p < 0.0001).

Generally, side effects in both groups were mild, and only 3 patients in the

alfacalcidol group and 2 patients in the vitamin D group had moderate

hypercalcemia. We conclude that alfacalcidol plus calcium is highly superior

to plain vitamin D3 plus calcium in the treatment of established GC induced

osteoporosis, and the latter should no longer be used as monotherapy. (J

Rheumatol 2005;32 Suppl 76:33-40)

http://www.jrheum.com/abstracts/abstracts05/76/33.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org