Comparison of calcium carbonate and aluminium hydroxide as phosphate binders on biochemical bone markers, PTH(1-84), and bone mineral content in dialysis patients.
Bone mineral content, estimated by single-photon absorptiometry of the forearm, serum values of intact parathyroid hormone (PTH(1-84], osteocalcin, alkaline phosphatase, 1,25-dihydroxycholecalciferol (1,25(OH)2D3), and aluminium were determined during treatment with calcium carbonate (CaCO3) or aluminium hydroxide (Al(OH)3) in 11 dialysis patients participating in a randomised cross-over study. Each treatment period lasted 6 months. Serum phosphorus was maintained in the range 1.5-2.0 mmol/l. During Al(OH)3 treatment bone mineral content (BMC) decreased by 11% per half-year (mean), but only by 3% per half-year during CaCO3 treatment (P less than 0.05). Comparing the CaCO3 and Al(OH)3 periods the following differences were found: serum calcium increased during CaCO3 treatment, PTH(1-84) decreased (79% of initial values during CaCO3 versus 196% during Al(OH)3, mean area under curve, P less than 0.05), osteocalcin decreased (89% versus 117%, P less than 0.01), alkaline phosphatase decreased (92% versus 116%, P less than 0.05), and aluminium decreased (56% versus 189%, P less than 0.05). 1,25(OH)2D3 remained unchanged in both periods. No increase in soft-tissue calcification was demonstrated on X-ray of the shoulders in any of the periods. Thus, CaCO3 treatment seems to slow down loss of bone mineral content, and using CaCO3 as phosphate binder may have a more beneficial effect on the progression of uraemic bone disease than Al(OH)3 due to the reduction of hyperparathyroidism and bone turnover.
Jespersen
B
B
Department of Medicine C, Aarhus Kommunehospital, Denmark.
Jensen
J D
JD
Nielsen
H K
HK
Lauridsen
I N
IN
Andersen
M J
MJ
Poulsen
J H
JH
Gammelgaard
B
B
Pedersen
E B
EB
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000535:Aluminum / Q000097:blood; D000536:Aluminum Hydroxide / Q000494:pharmacology*; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects; D002114:Calcinosis / Q000209:etiology; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000378:metabolism*; D006435:Renal Dialysis
D010281:Parathyroid Hormone; D010710:Phosphates; D015675:Osteocalcin; D000536:Aluminum Hydroxide; D000535:Aluminum; D000469:Alkaline Phosphatase; D002119:Calcium Carbonate; D002118:Calcium