妊娠期母体维生素D对子代骨骼生长的影响

妊娠期母体维生素D水平及生物活性上调,同时钙吸收水平也较孕前增加.孕期母体维生素D缺乏会影响胎儿血钙浓度,从而影响胎儿骨骼骨化,影响胎儿骨密度和骨矿积累,甚至导致胎儿出生低体重风险增加.妊娠期母体维生素D水平对婴儿期、儿童期的体重增长和骨量及骨密度也有一定的影响.这种影响与母体维生素D受体基因多态性和子代维生素D受体基因及蛋白的表达有关.鉴于维生素D不足普遍存在,孕期妇女需补充维生素D,然而对维生素D的补充剂量目前尚未有统一意见.     

348例婴儿骨源性碱性磷酸酶测定结果分析

目的检测婴儿血中骨源性碱性磷酸酶(BAP)活性,籍以筛查或早期发现维生素D(VitD)缺乏的婴儿,并辅助诊断因钙营养不良引起的骨钙化障碍或其他原因引起的代谢性骨病。并且早预防,早干预治疗。方法北京中生金域诊断技术有限公司提供的小儿骨源性碱性磷酸酶(NBAP)试剂盒,采用免疫渗滤和全血干化学技术原理,采末梢血进行测定。结果有临床症状的348例中≤200 U/L的5例,1.4%;200~300 U/L(不含)的129例,37.1%;≥300 U/L的214例,61.5%。结论结果显示,有临床症状的婴儿中BAP活性高于正常者十分多见,应引起重视,做好筛查,积极预防,系统管理,合理喂养,科学补充VitD。     

骨疏康胶囊治疗糖皮质激素性骨质疏松症的临床研究

目的观察骨疏康胶囊治疗糖皮质激素性骨质疏松症的疗效。方法选取宁夏医科大学总医院门诊及住院确诊的风湿性疾病并糖皮质激素性骨质疏松症患者80例,随机分为试验组和对照组,每组各40例。试验组患者口服骨疏康胶囊4粒BID,阿法骨化醇软胶囊0.5μg QD,碳酸钙D3片1片BID,对照组患者口服阿法骨化醇软胶囊0.5μg QD,碳酸钙D3片1片BID,两组均连续用药12个月,观察其骨密度及骨代谢指标的变化。结果试验组腰椎(L1~4)、股骨颈、大转子、全髋的骨密度均较对照组升高,与治疗前相比明显升高,差异均具有统计学意义(P0.05)。骨代谢指标中,试验组血清钙治疗前后无明显变化(P0.05),骨钙素、碱性磷酸酶降低,25-羟维生素D、Ⅰ型前胶原N端前肽升高,差异均有统计学意义(P0.05)。与对照组比较,血清钙与骨钙素无明显变化(P0.05),碱性磷酸酶降低,25-羟维生素D、Ⅰ型前胶原N端前肽升高,差异均具有统计学意义(P0.05)。结论骨疏康胶囊可改善糖皮质激素性骨质疏松症患者的骨密度和骨代谢,具有临床使用价值。     

甲状腺功能亢进症合并骨软化1例并文献复习

甲状腺功能亢进(简称甲亢)是导致碱性磷酸酶升高的原因之一,在甲亢的治疗过程中,如碱性磷酸酶进行性升高,伴骨痛,不能排除骨软化的可能性,值得引起注意。随着对代谢病骨病研究的深入,骨软化患者逐渐增多,病因包括维生素D摄入不足、维生素D吸收和代谢障碍、肾脏疾病(肾病综合征、慢性肾衰、肾小管酸中毒、范可尼综合征等),以及遗传性和肿瘤性低磷性骨软化,其他如重金属中毒、高氟摄入、某些药物等。然而,甲状腺功能亢进症患者出现骨质疏松多见,出现骨软化者较少见,罕有报道,容易漏诊和误诊。本文报道l例甲状腺功能亢进患者口服赛治(甲巯咪唑)后碱性磷酸酶进行性升高,伴全身骨痛,应用骨化三醇后碱性磷酸酶逐渐下降和骨痛消失。为此,甲亢治疗期间,结合国外文献报告,考虑骨软化可能性较大,密切观察患者碱性磷酸酶变化,给予积极对症治疗后,骨软化症状明显缓解。因此,应重视碱性磷酸酶的变化及临床特点,以明确是否合并骨软化并予尽早处理。     

“骨宝丸”防治佝偻病的实验研究

本文观察了佝偻病大鼠在用中药“骨宝丸”治疗前后血清钙、磷、碱性磷酸酶、２５羟基维生素Ｄ３及骨组织形态学和骨计量学的变化，并与维生素Ｄ３进行了比较。结果表明：“骨宝丸”防治佝偻病有效，特别是在提高血钙、血磷和降低血碱性磷酸酶以及促进类骨质矿化方面效果显著，但其作用机理与维生素Ｄ３不同。     

成都地区不同年龄城乡妇女维生素D和骨代谢指标及骨密度的状况分析

目的评价成都市不同年龄城乡女性居民血清25-羟基维生素D水平并计算维生素D缺乏和不足的患病率,计算各种骨转换指标的平均值,研究维生素D水平与骨转换指标的关系。方法选择2个城镇社区和2个农村社区,30~90岁健康妇女376例,采用酶联免疫法测定1,25-二羟基维生素D、25-羟基维生素D,化学发光免疫分析法测定骨碱性磷酸酶、胶原C端肽、N端骨钙素、抗酒石酸酸性磷酸酶、甲状旁腺素、1型前胶原氨基,用双能X线吸收仪检测腰椎骨密度。结果 25-羟基维生素D平均值为17.2±0.7 ng/m L,N端骨钙素平均值为7.6±0.3 ng/m L,1型前胶原氨基端肽平均值为59.6±4.2 ng/m L,维生素D不足者患病率为:97.0%,缺乏者患病率为:76.86%。同时,25-羟基维生素D与胶原C端肽、抗酒石酸酸性磷酸酶呈负相关,1,25-二羟基维生素D与骨碱性磷酸酶呈正相关关系。50岁以后骨密度显著下降。结论成都市女性居民在冬季维生素D普遍不足,不良的生活方式及低维生素D的摄人应引起重视。     

新疆乌鲁木齐汉族、维族骨量减少女性骨生化标志物和维生素D水平的研究

目的通过分析新疆乌鲁木齐地区汉族与维吾尔族骨量减少女性之间骨生化标志物和维生素 D的水平,探讨维吾尔族骨量减少的特点。方法选择2008年5月至2011年3月期间,我院就诊的 骨量减少的女性500例,其中汉族306例（61. 2% ),维族194例（38. 8% ),对比分析两组体重指数、血 清电解质、部分骨生化标记物以及25羟基维生素D水平。结果两组平均年龄、体重指数、血清Ca、 P、Mg水平无统计学差异（P>0. 05 );骨特异性碱性磷酸酶（BAP)无显著性差异（P>0. 05 );骨钙素 (BGP)、抗酒石酸酸性磷酸酶5b( TRACP-5b)水平,维吾尔族高于汉族组（P<0. 05);汉族各年龄阶段 VitD水平均高于维吾尔族,具有统计学显著性差异。结论骨转换水平较高和VitD缺乏在维吾尔族 女性骨量减少中发挥着重要的作用。     

EPCs移植对去卵巢大鼠骨质疏松的影响

目的研究EPCs移植对去卵巢大鼠骨质疏松的影响。方法将雌性未孕Wistar大鼠60只完全随机分为假手术组、模型组及EPCs组,每组20只。术后1周时行尾静脉注射治疗,连续注射7 d。定时测大鼠体重,13周时通过ELISA法检测血清25-羟基维生素D [25(OH) D]、骨特异性碱性磷酸酶(BAP)、Ⅰ型胶原C端肽(CTX-Ⅰ)及抗酒石酸酸性磷酸酶5b(TRAP5b)含量;运用RT-PCR、Western Blot检测椎体TGF-β/Smads表达变化。进一步行骨密度、骨钙含量及生物力学性能测定,通过HE染色观察病理变化。结果造模后8周起,模型组体重较假手术组明显升高(P0. 05); EPCs组体重与模型组比较明显降低(P0. 05);模型组骨密度及骨钙含量较假手术组明显降低(P0. 05); EPCs组骨密度和骨钙含量较模型组显著升高(P0. 05);与假手术组比较,模型组血清25(OH) D、BAP水平降低,CTX-Ⅰ、TRAP5b的水平升高(P 0. 05);与模型组比较,EPCs组血清25(OH) D、BAP水平升高,CTX-Ⅰ、TRAP5b水平降低(P0. 05)。生物力学检测表明,模型组极限载荷、极限应力和弹性模量明显低于假手术组(P0. 05),EPCs组的极限载荷和弹性模量比模型组显著增高(P0. 05)。HE染色显示EPCs移植后大鼠骨质疏松减轻。与模型组相比,EPCs组TGF-β1、Smad2、Smad3的表达显著升高(P0. 05)。结论 EPCs移植可能通过调控TGF-β/Smads通路发挥治疗去卵巢大鼠骨质疏松症的作用。     

甲状旁腺术后甲状旁腺激素升高伴血钙正常的病例分析

目的探讨因甲状旁腺功能亢进行甲状旁腺切除手术后患者出现甲状旁腺激素水平升高,而血钙正常的发生机制。方法对甲状旁腺手术后6个月的9 7例患者,监测甲状旁腺激素;手术前和手术后6个月,测定2 5-羟基维生素D、血清碱性磷酸酶、骨原蛋白,骨密度。术后6个月测定甲状旁腺激素对于钙沉积的反应。结果 3 0例患者的术后血钙正常而甲状旁腺激素升高。术前,此30例患者甲状旁腺激素和肌酐较高,维生素D水平低,有广泛的骨质改变。其余6 7例患者,术后甲状旁腺激素正常,肾功能和维生素D正常,无骨质改变。结论手术后,甲状旁腺激素水平升高,是对肾功能衰竭和维生素D缺乏的适应性反应。     

骨质疏松症的预防应该重视孕妇和儿童的骨骼健康

骨质疏松症已成为全球关注的公共卫生热点,骨质疏松症人群占中国总人口数的7.01%.骨质疏松症被称为"具有老年期影响的儿科疾病".孕妇的营养状况直接影响胎儿的骨状况,从而影响人体一生的骨骼生长发育.佝偻病和骨软化症是儿童时期最常见的骨骼疾病.维生素D、钙、磷供给不足都可以导致佝偻病,影响骨量、骨强度,甚至导致骨骼畸形.一些慢性疾病和药物也可导致儿童骨质疏松症,如少年特发性骨质疏松症、类风湿性关节炎、糖皮质激素、甲状腺激素诱导的骨质疏松症等.妊娠期和哺乳期妇女也可发生特发性骨质疏松症.人体骨量从胎儿期、婴儿期到成年期前一直在聚集,此过程与人体的线性生长基本平行.胎儿期、婴儿期和青春期是人体骨骼生长发育最重要时期.骨量峰值在成年早期获得,它是成年人骨强度的重要决定因素,称为"成人期骨银行".在儿童和青少年时期未达到合理骨量的个体,即使成年后无加速骨量流失现象发生,仍有可能患骨质疏松症.孕妇和儿童骨状况评估的物理方法包括X光片法、双能X线吸收法(DXA)、定量超声法(QUS)等.由于考虑到射线辐射、技术和价格等因素影响,X光片法和DXA的应用目前受到限制.定量超声设备测量宽波衰减值(BUA)和声波速度值(SOS)等参数来反映骨强度,显示出广泛的前景.常见的骨代谢生化指标包括碱性磷酸酶、骨碱性磷酸酶、骨钙素和钙调激素等.测量血液中1,25(OH)D3水平可以反应人体维生素D状况,将在临床上不断普及应用.为了强壮骨骼预防骨质疏松症,应该设法创造理想的骨骼发育环境,最大限度的达到骨量或骨强度峰值,并定期进行骨状况评估,及时发现异常和早期干预,尽可能地减少骨折发生.营养和体力活动对骨骼发育有重要影响.妊娠期、哺乳期的妇女和儿童应保证合理营养、适当户外活动和日光照射,推广强化维生素D和钙的食品;并且,妊娠期、哺乳期妇女和儿童应该补充维生素D和钙.     

Newborn bone mineral density and health care during pregnancy

To study the effects of calcium and vitamin D supplements on bone mineral density (BMD) of perinatal women and their newborns, a follow-up study was performed to examine the BMD of 110 normal pregnant women from mid- to late-term pregnancy to delivery and of their 110 newborns and 30 preterm newborns. BMD was examined using single-photon absorptiometry. In the first experiment, 31 women took a supplement of 0.3 g calcium lactate plus 400 IU vitamin D per day, while 79 received no supplement during their pregnancy. The results showed that the radial BMD of mothers who took calcium lactate during their pregnancy and the tibial BMD of their newborns were significantly higher than those when no supplement of calcium was taken. In the second experiment, it was found that the BMD of preterm newborns was significantly lower than that of normal newborns. This study suggested that advocating pregnancy hygiene, giving a proper dosage of calcium and vitamin D, and improving nutrition during pregnancy can prevent osteoporosis in women and benefit newborn development. It is also shown that a quantitative assessment of BMD might prove useful in the follow-up of newborn and infant development.. Received: Sept. 18, 1997 / Accepted: March 17, 1998     

活性维生素D对骨量减少的强直性脊柱炎患者骨代谢指标及病情的影响

目的探讨补充活性维生素D对于骨量减少的强直性脊柱炎(AS)患者骨代谢标志物、骨密度及炎性指标的影响。方法选取骨量减少的AS患者60例为研究对象,同期健康体检者20例作为健康组,比较两组受试者血清骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶异构体-5b(TRACP-5b)、25-(OH)D3的水平。将上述AS患者随机分为治疗组和对照组,每组30例,对照组口服美洛昔康、柳氮磺吡啶、碳酸钙,治疗组在此基础上加用骨化三醇口服。比较2组治疗前后BALP、TRACP-5b、25-(OH)D3,骨密度(BMD)以及红细胞沉降率(ESR)、C反应蛋白(CRP)等指标的变化水平。结果 AS组BALP、TRACP-5b高于健康组,25-(OH)D3低于健康组(P0.05)。治疗组和对照组治疗后血清BALP、25-(OH)D3水平均有升高(P0.05),TRACP-5b水平均有下降(P0.05);治疗组BALP及25-(OH)D3治疗前后差值高于对照组(P0.05)。6个月后治疗组复查腰椎、大转子、转子间BMD较对照组均有不同程度的提升(P0.05),5例骨量恢复正常;对照组6个月后BMD变化不明显;治疗组治疗前后腰椎、大转子、转子间BMD变化差值均高于对照组(P0.05);治疗组与对照组ESR、CRP及BASDAI评分较前均有所降低(P0.05),其中治疗组ESR下降水平较对照组差异具有统计学意义(P0.05)。结论活性维生素D可以改善骨量减少的强直性脊柱炎患者的骨代谢指标并降低疾病活动度。     

Effects of vitamin K2 in hemodialysis patients with low serum parathyroid hormone levels

In patients with adynamic bone disease, the bone contains few osteoblasts or osteoclasts and bone turnover is slow, so the risk of fracture is increased. The decrease of bone remodeling may also decrease the capacity of bone to buffer calcium, leading to an increase of the calcium x phosphate product and an increased risk of arterial calcification. Such findings emphasize that an effective treatment for adynamic bone disease is required. The present study investigated the influence of vitamin K2 (menatetrenone) on hemodialysis patients with low serum parathyroid hormone levels by using bone metabolism markers. The subjects were 32 hemodialysis patients (19 men and 13 women) aged from 27 to 76 years with an intact parathyroid hormone (PTH) level of less than 65 pg/ml and an intact osteocalcin level below 20 ng/ml. All patients received oral menatetrenone therapy (45 mg/day) for 12 months. To obtain control data on bone metabolism markers in hemodialysis patients with normal bone turnover, we selected 50 patients who had intact PTH levels within the range that maintains relatively normal bone turnover, that is, from 120 to 250 pg/ml. The baseline levels of all bone metabolism markers were significantly lower in our patients than in the normal PTH control group. There was a significant increase of gamma-carboxyglutamate (Gla) osteocalcin, bone alkaline phosphatase (B-ALP), tartrate-resistant acid phosphatase (TRACP), and cross-linked N-terminal telopeptide of type 1 collagen (NTx) levels after vitamin K2 administration. Type 1 procollagen carboxyterminal propeptide (P1CP) and intact osteocalcin both showed a significant increase after 12 months of treatment. Although there was no significant change of the alkaline phosphatase (ALP) level during the 12 months before the start of vitamin K2 therapy, there was a significant increase of alkaline phosphatase after vitamin K2 administration. Adjusted calcium, serum phosphate, and intact PTH showed no significant changes throughout the study. These changes of bone metabolism markers suggested that vitamin K2 therapy can improve bone remodeling in hemodialysis patients with low serum PTH levels.     

婴儿早期骨代谢生化指标与声波速度值和出生后年龄间的关系

目的 探讨婴儿早期骨代谢生化指标与声波速度值和出生后年龄间的关系.方法 采用骨定量超声(QUS)仪对167例出生3月内的婴儿进行胫骨声波速度(SOS)测量.其中包括53例早产儿(胎龄:32.6±2.7周)和114例足月儿(胎龄:39.1±1.2周);同时在部分婴儿中测量血钙、磷、碱性磷酸酶(ALP)和骨碱性磷酸酶(BALP).结果 ①早产儿和足月儿的血钙、磷、ALP和BALP值之间均差异无显著性.②婴儿骨SOS值与ALP呈显著负相关(n=167,r=-0.139,P=0.036)、与BALP也显著负相关(n=32,r=-0.410,P=0.010);SOS值与血钙、血磷及血钙磷乘积无显著性相关.在早产儿中,ALP和BALP与日龄均显著相关,相关系数r分别为0.286(n=53,P=0.019)和0.946(n=7,P=0.001);在足月儿中未发现显著相关性.血磷与日龄呈显著负相关(n=24,r=-0.509,P=0.005).③ALP与BALP高度相关(n=32,r=0.958,P=0.001),BALP占ALP活力的47.3%.早产儿在出生时BALP和Ⅰ型胶原羧基端肽(IcTP)显著正相关(n=36,r=0.768,P=0.001).结论 定量超声技术测量SOS有助于我们评估婴儿早期骨状况;在此横向研究中我们发现骨SOS与骨代谢生化指标之间存在相关性,然而,二者间的纵向关系有待于进一步研究.     

FGF23 is elevated in Gambian children with rickets

OBJECTIVES: Fibroblast growth factor 23 (FGF23) is a phosphaturic factor that is elevated in several diseases associated with hypophosphatemia and rickets. Rickets in the absence of vitamin D deficiency has been reported in African and Asian populations with a low calcium intake but the definition of risk factors has proved elusive. The aim of the study was to characterize the biochemical profile and measure FGF23 in a series of Gambian children who had presented with rickets of unknown etiology and a plasma 25-hydroxyvitamin D (25OHD) above the range typical of vitamin D-deficiency rickets. METHODS: The 46 patients (30 males, 16 females) had bone deformities typical of rickets and were 1.1-16.4 years old (geometric mean, 3.4 years). Active rickets (on radiographs and/or elevated plasma alkaline phosphatase) was present in 28%. Plasma 25-hydroxyvitamin D was above 20 nmol/l in all patients. Concentrations of plasma FGF23, phosphate and other relevant biochemical analytes were measured in stored samples of fasting, early morning plasma and compared with those measured in samples collected from local children and stored under similar conditions. RESULTS: The rickets patients had lower plasma phosphate, lower 25-hydroxyvitamin D, higher 1,25-dihydroxyvitamin D and elevated total alkaline phosphatase than local children. Those with active rickets had raised parathyroid hormone concentration. The patients had significantly higher FGF23 concentration than local children (geometric mean (-1SD, +1SD, range) RU/ml: 367 (87, 1552, 46-7052, n=39) vs 51 (23, 112, 3-130, n=30), p相似文献   

The influence of folic acid supplementation on maternal and fetal bone turnover

The aim of our study was to investigate the relationship between maternal and fetal bone turnover markers and folic acid supplementation during pregnancy. In an observational study performed in Tehran University of Medical Sciences related hospitals, 113 healthy pregnant women with gestational age between 8 and 12 weeks and aged between 15 and 42 years were recruited and followed until delivery time. The participants were divided into two groups; women who took 1 mg of folic acid daily supplement from the beginning of the pregnancy until the end of the second trimester entered into group I and women who choose to continue their daily intake of folic acid until the delivery time entered into group II. The two groups were matched based on the maternal anthropometric data, energy, calcium and vitamin D intake. Following the delivery, venous blood samples were collected from mothers and umbilical cords of the neonates. Maternal and fetal serum concentrations of 25-hydroxy vitamin D3, PTH, osteocalcin (OC), crosslaps and maternal serum level of homocysteine, folate, soluble receptor activator of NF-kappaB ligand (sRANKL), osteoprotegerin (OPG), calcium, and phosphate were measured. Measured birth outcome parameters included weight, length, head circumference, appearance, and respiration. With regard to maternal assessment, the serum levels of OC and OPG and folate were significantly higher in group II compared to group I, while the serum levels of RANKL and homocysteine were significantly higher in group I. We did not find significant differences in serum levels of 25-OH vitamin D, PTH, crosslaps, calcium, or phosphate between the two groups. The neonates from mothers recruited in group II had higher (but not significantly) serum level of OC. We observed that the neonates born from mothers in group II had overall better birth outcome parameters and apgar scores compare to the neonates born from mothers in group I. Our results show that daily supplementation of folic acid during pregnancy could have a positive impact on the bone turnover markers in mothers and their newborns. This may suggest that both pregnant mothers and their fetuses could benefit from positive effects of folic acid taken during the whole period of pregnancy.     

Perinatal bone turnover in term pregnancies: the influence of intrauterine growth restriction

Intrauterine growth restriction (IUGR) has been associated with low bone mass in infancy and increased risk for osteoporosis development in adult life. We aimed to investigate the effect of IUGR on bone metabolism in mother/infant pairs, by determining circulating biochemical markers of bone turnover in IUGR and appropriate for gestational age (AGA) pregnancies. Circulating markers of bone formation [bone specific alkaline phosphatase (BALP), total alkaline phosphatase (ALP), osteocalcin (OC)] and bone resorption [cross-linked N-telopeptide of type I collagen (NTx)], as well as intact parathormone (PTH), calcium and phosphorus levels were measured in 40 mothers and their 20 IUGR and 20 AGA singleton full-term fetuses and neonates on postnatal days 1 (N1) and 4 (N4). No significant differences in BALP, ALP, OC, NTx, PTH, calcium or phosphorus levels were observed between the AGA and the IUGR groups. In both groups, maternal BALP levels were lower compared to fetal, N1 and N4 levels (p< or =0.005 in all cases). In the AGA group, maternal NTx and OC levels were lower compared to fetal, N1 and N4 levels (p<0.001 in all cases), and fetal NTx levels were lower compared to N1 and N4 ones (p<0.001 and p=0.002, respectively). In the IUGR group, maternal OC levels were lower compared to fetal, N1 and N4 ones (p<0.001 in each case) and fetal OC levels were elevated compared to N1 and N4 ones (p<0.001 and p=0.003, respectively). N4 NTx levels were elevated compared to maternal, fetal and N1 levels (p=0.009, p<0.001 and p=0.002, respectively) and fetal NTx levels were lower compared to N1 and N4 ones (p=0.001 and p<0.001, respectively). Finally, positive correlations were found between maternal NTx and BALP (r=0.332, p=0.037), as well as ALP (r=0.329, p=0.038) levels, and between maternal, fetal, N1, N4 BALP and respective ALP levels (r=0.432, p=0.005, r=0.534, p=0.001, r=0.778, p<0.001, r=0.694, p<0.001, respectively). In conclusion, maternal, fetal and neonatal bone turnover in IUGR cases may not differ from respective bone metabolism in AGA controls. In addition, fetal and neonatal bone remodeling is markedly enhanced and independent of maternal bone turnover in late pregnancy.     

云克治疗绝经后骨质疏松93例临床观察

目的评价云克治疗绝经后骨质疏松症的疗效。方法 93例绝经后骨质疏松症患者随机分为治疗组58例和对照组35例。治疗组采用云克注射治疗和服用维生素D制剂,10～15d为1个疗程,连续三个疗程;对照组常规口服钙剂。分别观察2组治疗前及治疗后3、6、12个月血中骨钙素(BGP)、骨特异性碱性磷酸酶(BALP)及骨密度(BMD)变化。结果治疗组治疗3个月后BGP值开始下降,而BALP则在治疗后6个月逐渐降低,BMD值在治疗后12个月较治疗前增加,与对照组比较差异均有统计学意义(P<0.05);对照组治疗前后3项指标均无差异。结论云克对骨组织具有明显的导向性,抑制破骨细胞活性,抑制骨丢失,增加骨强度,对绝经后骨质疏松有较好疗效。     

Is there a differential response to alfacalcidol and vitamin D in the treatment of osteoporosis?

There is a decline in serum 25 hydroxyvitamin D (25OHD), 1,25 dihydroxyvitamin D (1,25(OH)₂D), and calcium absorption with advancing age, which may lead to secondary hyperparathyroidism and bone loss. Studies show a relationship between serum 25OHD and bone density in older men and women, with an inverse correlation between bone density and parathyroid hormone (PTH). Vitamin D supplementation in this age group improves calcium absorption, suppresses PTH, and decreases bone loss. Vitamin D many also reduce the incidence of hip and other nonvertebral fractures, particularly in the frail elderly who are likely to have vitamin D deficiency. Patients with established vertebral osteoporosis have lower calcium absorption than age-matched control subjects, possibly due to reduced serum 1,25(OH)₂D or to relative resistance to the action of vitamin D on the bowel. Malabsorption of calcium in women with vertebral crush fractures does not usually respond to treatment with physiological doses of vitamin D, but can be corrected by pharmacological doses of vitamin D or by low doses of calcitriol or alfacalcidol. In a recent randomized, controlled study in 46 elderly women with radiological evidence of vertebral osteoporosis, alfacalcidol 0.25 μg twice daily improved calcium absorption, decreased serum PTH, and reduced alkaline phosphatase, whereas vitamin D₂ 500–1000 IU daily had no effect over the 6-month study period. Studies of the effect of the vitamin D metabolites in the management of elderly women with established vertebral osteoporosis have yielded conflicting results, but suggest that alfacalcidol and calcitriol may decrease spinal bone loss and reduce the incidence of vertebral fractures. Although vitamin D supplementation decreases bone loss and fracture risk in the frail elderly, vitamin D metabolites may prove more useful in the treatment of elderly women with vertebral osteoporosis.