title: The effects of calcitriol on improvement of insulin resistance, ovulation and comparison with metformin therapy in PCOS patients: a randomized placebo- controlled clinical trial.
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of reproductive age. Insulin resistance is a frequent metabolic disturbance in PCOS. Vitamin D deficiency is a common problem. Accumulating evidence suggests that vitamin D has a role on insulin sensitivity so may contribute to reduction of hyperandrogenemia.
  
  
  OBJECTIVE
  The aim was to determine the effects of vitamin D treatment in metabolic components and ovulation evidence in PCOS.
  
  
  METHODS
  Fifty one untreated PCOS patients were randomly divided into three groups and treated with calcitriol, metformin, or placebo. Before and 3 months after treatment, ovulation evidence was assessed by ovarian trans abdominal sonography. Plasma fasting glucose, insulin, homeostasis model assessment insulin resistance (HOMA-IR), 25-hydroxyvitamin D, parathyroid hormone and androgen levels were measured before and after treatment. A 75gr glucose test was performed before and after treatment and two set of results was compared.
  
  
  RESULTS
  Three patients did not continue this study. Only 11 patient (22.9%) had sufficient vitamin D levels (>30 ng/ml). Metformin caused a significant decrease in weight (p=0.027), insulin level (p=0.043), and insulin resistance (p=0.048). Systolic blood pressure and PTH significantly improved after calcitriol (p=0.029, p=0.009 respectively). An improvement in ovulation was detected after calcitriol and seven patients, without evidence of ovulation before treatment, illustrated ovulation after 3 months. Difference with calcitriol in ovulation was significant versus other two methods (p=0.02).
  
  
  CONCLUSIONS
  Calcitriol treatment in PCOS may be prior to metformin in ovulation induction.
authors.affiliation: Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Shokoufeh
authors.initials: S
authors.lastname: Bonakdaran
authors.affiliation: Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mazloom Khorasani
authors.affiliation: Department of Radiology, Radiology Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Davachi
authors.affiliation: Imam Reza Hospital, Mashhad, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Mazloom Khorasani
keywords: Insulin resistance; Ovulation; PCOS; Vitamin D