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This open-label randomized controlled study evaluated calcitriol alone or combined with calcium carbonate versus calcium carbonate alone for preventing and treating glucocorticoid-induced osteoporosis in 66 patients with primary nephrotic syndrome, assessing serum bone metabolism markers and bone mineral density (BMD) at baseline, 12 weeks, and 24 weeks. After glucocorticoid therapy, markers including 25-hydroxy vitamin D, osteocalcin, and total serum collagen type N-terminal extension decreased while β-collagen serum-specific sequences increased, and these changes were less pronounced in calcitriol-treated groups, though calcium, phosphorus, alkaline phosphatase, and PTH changes were not significant; BMD decreased at 24 weeks in all groups, but lumbar spine BMD was significantly higher with calcitriol (with or without calcium) than with calcium carbonate alone, and no serious adverse events were observed. The paper’s main caveat is its open-label design. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.
Abstract
OBJECTIVE: To evaluate the efficacy and safety of calcitriol in the prevention and treatment of glucocorticoid-induced osteoporosis. METHODS: 66 patients treated with glucocorticoids (GC) for primary nephrotic syndrome (NS) were randomly assigned to 3 groups. Groups were designated as follows: calcitriol alone (n = 22), calcitriol plus calcium carbonate (n = 23), or calcium carbonate alone (n = 21). Serum markers of bone metabolism and bone mineral density (BMD) were tested at 3 different time points: the initiation of GC treatment (baseline), 12 weeks, and 24 weeks after the initiation of treatment. RESULTS: Levels of serum 25-hydroxy vitamin D, serum osteocalcin, and total serum collagen type N-terminal extension of the peptide were significantly decreased following GC therapy (p < 0.05). β-collagen serum-specific sequences were significantly increased following GC therapy. The above-mentioned changes were less dramatic in patients treated with calcitriol, although the differences were significant (p < 0.05). Changes in serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) were not significant. 24 weeks after the initiation of treatment, BMD of the lumbar spine and femoral bone significantly decreased in all of 3 groups. However, patients who received calcitriol had significantly higher BMD of the lumbar spine than patients who received calcium carbonate alone (calcitriol plus calcium carbonate vs. calcium carbonate alone: 0.82 ± 0.19 g/cm2 vs. 0.62 ± 0.23 g/cm2 p < 0.05; calcitriol vs. calcium carbonate alone 0.805 ± 0.203 g/cm2 vs. 0.615 ± 0.225 g/cm2 p < 0.05), respectively. No serious adverse events were observed. CONCLUSION: Calcitriol may be more effective than calcium carbonate in preventing and treating GC-induced osteoporosis in patients with NS.
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Efficacy of calcitriol in treating glucocorticoidinduced osteoporosis in patients with nephrotic syndrome: an open-label, randomized controlled study
Yi Chen, Jian-Xin Wan, De-Wen Jiang, Bin-Bin Fu, Jiong Cui, Gui-Fen Li, Cai-Ming Chen
Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
DOI 10.5414/CN108473
Abstract
Objective: To evaluate the efficacy and safety of calcitriol in the prevention and treatment of glucocorticoid-induced osteoporosis. Methods: 66 patients treated with glucocorticoids (GC) for primary nephrotic syndrome (NS) were randomly assigned to 3 groups. Groups were designated as follows: calcitriol alone (n = 22), calcitriol plus calcium carbonate (n = 23), or calcium carbonate alone (n = 21). Serum markers of bone metabolism and bone mineral density (BMD) were tested at 3 different time points: the initiation of GC treatment (baseline), 12 weeks, and 24 weeks after the initiation of treatment. Results: Levels of serum 25-hydroxy vitamin D, serum osteocalcin, and total serum collagen type N-terminal extension of the peptide were significantly decreased following GC therapy (p < 0.05). β-collagen serum-specific sequences were significantly increased following GC therapy. The above-mentioned changes were less dramatic in patients treated with calcitriol, although the differences were significant (p < 0.05). Changes in serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) were not significant. 24 weeks after the initiation of treatment, BMD of the lumbar spine and femoral bone significantly decreased in all of 3 groups. However, patients who received calcitriol had significantly higher BMD of the lumbar spine than patients who received calcium carbonate alone (calcitriol plus calcium carbonate vs. calcium carbonate alone: 0.82 ± 0.19 g/cm2 vs. 0.62 ± 0.23 g/cm2 p < 0.05; calcitriol vs. calcium carbonate alone 0.805 ± 0.203 g/cm2 vs. 0.615 ± 0.225 g/cm2 p < 0.05), respectively. No serious adverse events were observed. Conclusion: Calcitriol may be more effective than calcium carbonate in preventing and treating GC-induced osteoporosis in patients with NS.
Author Details
Authors
Departments
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
Address
Jian-Xin Wan, PhD
Department of Nephrology
The First Affiliated Hospital of Fujian Medical University
Fuzhou 350005, China
Email:
[email protected]
Citation
Yi Chen, Jian-Xin Wan, De-Wen Jiang, Bin-Bin Fu, Jiong Cui, Gui-Fen Li, and Cai-Ming Chen.Efficacy of calcitriol in treating glucocorticoidinduced osteoporosis in patients with nephrotic syndrome: an open-label, randomized controlled study. 2015; 84: 262-269. doi: 10.5414/CN108473.
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