Overcoming resistance to bisphosphonates through the administration of alfacalcidol: results of a 1-year, open follow-up study.
This study intended to determine whether the replacement of vitamin D3 with alfacalcidol results in any bone mineral density (BMD) increase in 76 patients unresponsive to the combination of alendronate and conventional vitamin D3 treatment. In these patients the conventional vitamin D3 had been replaced with alfacalcidol (0.5 μg/day), and then the patients were followed up for a year. After treatment for 1 year, Wilcoxon test revealed a small but statistically significant (P < 0.001) increase in the BMD values of the forearm and lumbar vertebrae, in the serum calcium and urinary calcium/creatinine ratio in first-voided morning urine. However, the serum alkaline phosphatase activity, phosphorus, parathormone, osteocalcin levels and the urinary d-pyr/creatinine ratio decreased significantly (P < 0.001). As suggested by our results, combination therapy with alendronate and alfacalcidol increases bone density and improves the biochemical markers of bone turnover, without any substantial increase in the incidence of adverse effects.
Gaál
János
J
Department of Rheumatology and Physical Therapy, Kenézy Gyula Hospital, BartókBéla u 2-26, 4043 Debrecen, Hungary. gaalja@freemail.hu
Bender
Tamás
T
Varga
József
J
Horváth
Irén
I
Kiss
Judit
J
Somogyi
Péter
P
Surányi
Péter
P
D015502:Absorptiometry, Photon; D000368:Aged; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000652:urine; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D002762:Cholecalciferol / Q000009:adverse effects / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006814:Hungary; D006887:Hydroxycholecalciferols / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006887:Hydroxycholecalciferols; D002762:Cholecalciferol; C008088:alfacalcidol; D019386:Alendronate