title: Effects of pamidronate and calcitriol on the set point of the parathyroid gland in postmenopausal hemodialysis patients with secondary hyperparathyroidism.
abstract: OBJECTIVE
  Secondary hyperparathyroidism may worsen after the administration of pamidronate in postmenopausal hemodialysis (HD) patients. The aim of this study was to evaluate the short-term effect of coadministration of calcitriol and pamidronate on dynamic parathyroid hormone (PTH) secretion.
  
  
  METHODS
  Fifteen postmenopausal women undergoing regular HD with serum intact PTH levels of >200 pg/ml were enrolled. The PTH-ionized calcium (iCa) curve was evaluated by the response to hypo- and hypercalcemia induced with 1 and 4 mEq/l of dialysate calcium, respectively. Parameters were compared after pamidronate was administered and after coadministration of pamidronate and calcitriol. Changes in serum levels of maximal serum PTH (PTHmax), basal PTH (PTHbase) and minimal PTH (PTHmin) were evaluated.
  
  
  RESULTS
  Pamidronate therapy resulted in a decrease in predialysis basal plasma iCa (p < 0.05) and an increase in PTHmax (p < 0.01), PTHbase (p < 0.01) and PTHmin (p < 0.01). The change in serum iCa and PTH was reversed after the coadministration of calcitriol and pamidronate.
  
  
  CONCLUSIONS
  Our study demonstrated that pamidronate therapy is associated with a reduced plasma iCa and increased PTH secretion. These adverse effects may be reversed by calcitriol. These findings suggest that in considering pamidronate treatment in postmenopausal patients with osteoporosis receiving HD, it might be safer to add calcitriol to prevent the increased PTH secretion.
authors: Department of Medicine, Show-Chwan Memorial Hospital, Changhua, Taiwan, ROC.
authors: Chung-Yu
authors: CY
authors: Huang
authors: Cai-Mei
authors: CM
authors: Zheng
authors: Chia-Chao
authors: CC
authors: Wu
authors: Lan
authors: L
authors: Lo
authors: Kuo-Cheng
authors: KC
authors: Lu
authors: Pauling
authors: P
authors: Chu
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood*; D002120:Calcium Channel Agonists / Q000008:administration & dosage; D004164:Diphosphonates / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood*; D017698:Postmenopause / Q000097:blood / Q000187:drug effects; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D002120:Calcium Channel Agonists; D004164:Diphosphonates; D010281:Parathyroid Hormone; D002117:Calcitriol; D000077268:Pamidronate; D002118:Calcium