The efficacy and safety of calcitriol and/or Caltrate D in elderly Chinese women with low bone mass

Aim： To observe the efficacy and safety of Rocaltrol （calcitriol） and/or Caltrate D （calicum carbonate plus vitamin D） in elderly Chinese women with osteopenia or osteoporosis.
Methods： One hundred fifty Chinese women aged over 65 years with osteopenia or osteoporosis from three centers were randomly divided into two groups. Seventy-six participants received Caltrate D as one pill daily; the other 74 participants received 0.25 μg Caltrate D plus Rocaltrol daily. The changes in bone mineral density （BMD） served as primary end-points. Height changes, the presence of new vertebral fractures, muscle strength and balance were evaluated.
Results： The following are the mean percentage changes （and SD） in BMD over 12 months： at L2-L4, 0.83±3.88 in the Caltrate D group and 2.84±4.04 in the Rocaltrol＋Caltrate D group （P=0.003, by ANCOVA ）; at the femoral neck, 0.04±3.94 in the Caltrate D group and 2.01±5.45 in the Rocaltrol＋Caltrate D group （P=0.085, by ANCOVA）; and in the trochanter, 1.59±4.57 in the Caltrate D group and 3.76±6.25 in the Rocaltrol＋Caltrate D group （P=0.053, by ANCOVA）. The stand and maximal forward reach test （SMFRT） was significantly enhanced in both groups during the 12 months of treatment, but no significant differences were found between these two groups. No severe adverse event related to these medications occurred throughout the study.
Conclusion： Treatment with Rocaltrol plus Caltrate D or Caltrate D for 12 months in elderly Chinese postmenopausal women effectively increased BMD at the lumbar spine. Rocaltrol plus Caltrate D was more effective at the lumbar spine than Caltrate D alone.     

维生素D受体、胃蛋白酶原C与TP53基因及其多态性与乳腺癌的研究进展

维生素D受体(VDR)是类固醇激素和甲状腺受体超家族成员,具有抑制增殖、诱导乳腺癌细胞凋亡的功能;蛋白水解酶是胃蛋白酶原C(PGC)或胃亚蛋白酶的前体,是反映乳腺癌早期复发和死亡的新型预后因素;而TP53基因突变及其过表达见于乳腺癌的早期阶段,是乳腺癌发生的早期事件.基因多态性将会为乳腺癌的治疗提供新的治疗方向.     

Successful treatment of severe secondary hyperparathyroidsm (Brown tumor) by kidney transplantation and pulses of oral calcitriol

Abstract:  Brown tumor is an extreme form of severe hyperparathyroid bone disease in end-stage renal disease patients. The evolution of the tumor after renal transplantation and under conservative treatment is still unclear. Herein, we report a 22-yr-old girl with parathyroid glandular hyperplasia because of an inadequate compliance and control of the mineral metabolism and subsequently developed Brown tumor of the ribs. A gradual improvement in bone and parathyroid gland status was observed within three yr following successful kidney transplantation and treatment with pulses of oral calcitriol. To the best of our knowledge, this is the first case of such severe secondary hyperparathyroidism with successful conservative treatment in the setting of kidney transplantation with no evidence of vascular calcifications and graft failure.     

Vitamin D and Immune Function

Vitamin D metabolizing enzymes and vitamin D receptors are present in many cell types including various immune cells such as antigen-presenting-cells, T cells, B cells and monocytes. In vitro data show that, in addition to modulating innate immune cells, vitamin D also promotes a more tolerogenic immunological status. In vivo data from animals and from human vitamin D supplementation studies have shown beneficial effects of vitamin D on immune function, in particular in the context of autoimmunity. In this review, currently available data are summarized to give an overview of the effects of vitamin D on the immune system in general and on the regulation of inflammatory responses, as well as regulatory mechanisms connected to autoimmune diseases particularly in type 1 diabetes mellitus.     

A study of codispensing with sodium alendronate in Australia

AIM: To estimate the percentage of patients dispensed alendronate who were also dispensed another drug for treatment of an upper gastrointestinal disorder ('GI' drug). METHODS: The Australian Health Insurance Commission (HIC) Pharmaceutical Benefits Scheme (PBS) database was searched to identify a cohort of patients for whom alendronate or calcitriol had been dispensed and had also been dispensed a GI drug. RESULTS: The number of patients dispensed a GI drug were 6.7% for alendronate and 7.5% for calcitriol with H(2)-receptor antagonists accounting for the majority of usage. This difference of - 0.8% (95% confidence interval -1.6, 0.1) is not significant. CONCLUSION: There was no excess use of GI drugs in patients taking alendronate compared with those taking calcitriol and the Australian HIC PBS database is useful for identifying large numbers of patients who have been dispensed combinations of drugs.     

Multiple cycles of intermittent chemotherapy in metastatic androgen-independent prostate cancer

Recently, completed phase III studies demonstrated a survival benefit for a fixed number of cycles of docetaxel-containing chemotherapy treatment of androgen-independent prostate cancer (AIPC). Management of patients who respond well to initial chemotherapy for AIPC remains ill-defined. We previously reported that in a select group of such patients, retreatment with the same regimen was feasible and was associated with quality of life gains. Here, we report that multiple cycles of such intermittent chemotherapy are feasible. We prospectively tested intermittent chemotherapy in eight AIPC patients responding to calcitriol plus docetaxel who reached a serum prostate-specific antigen (PSA) <4 ng ml(-1) (22% of the 37 patients who were initially treated with this regimen). Chemotherapy was suspended until a rise in PSA > or =50% and 1 ng ml(-1). The median duration of the first treatment holiday was 20 weeks (13-74 weeks) and all patients retained sensitivity to retreatment. Four patients were eligible for a second chemotherapy holiday, and the median duration was 21 weeks (17-28 weeks). Two patients elected to take a third chemotherapy holiday, which lasted 10 and 28 weeks. The median time to treatment failure was 26.5 months (95% CI 23.6-29.4 months), and the median survival is 41 months (95% CI 33.7-48.3 months). Multiple cycles of intermittent chemotherapy interrupted by clinically meaningful treatment holidays are feasible in a subset of AIPC patients treated with this docetaxel-containing regimen. Intermittent chemotherapy for AIPC is feasible and deserves further study.     

Intermittent chemotherapy in metastatic androgen-independent prostate cancer

Intermittent use of chemotherapy for androgen-independent prostate cancer (AIPC) instead of treatment until disease progression may reduce toxicity. We prospectively tested this approach in eight AIPC patients responding to calcitriol plus docetaxel who reached a serum prostate-specific antigen (PSA) <4 ng ml(-1). Chemotherapy was suspended until a rise in PSA>/=50% and 1 ng ml(-1). The median duration of treatment holiday was 20 weeks (13-43+weeks) and all patients retained sensitivity to re-treatment. Chemotherapy holiday was associated with an improvement of fatigue (P=0.05). Intermittent chemotherapy for AIPC is feasible and deserves further study.     

骨化三醇加钙剂治疗肾性骨营养不良

目的：探讨肾性骨营养不良（ＲＯＤ）的治疗方法。方法：对６８例（男性３９例,女性２９例,年龄５１ａ±ｓ６ａ）长期腹膜透析的慢性肾功能衰竭病人,采用单交叉设计,分别给予骨化三醇及骨化三醇加钙剂（葡萄糖酸钙）治疗,观察尺桡骨骨密度（ＢＭＤ）、血清钙、磷、甲状旁腺激素（ＰＴＨ）水平的变化,并对２种治疗方法的结果进行比较。结果：２种治疗均可显著增加ＢＭＤ,血清钙水平,降低血清磷及ＰＴＨ水平,但后一种治疗与前一种比较,疗效更为显著（Ｐ＜０．０１）。结论：钙剂加骨化三醇治疗ＲＯＤ优于单用骨化三醇。     

Pseudovitamin D deficiency rickets--a report from the Indian subcontinent

Pseudovitamin D deficiency rickets (also called vitamin D dependent rickets type I) is one of the types of inherited rickets and is caused by a deficit in renal 25-hydroxyvitamin D 1alpha-hydroxylase. This form of rickets has not been reported from the Indian subcontinent. Three patients with this disorder are presented. These patients were all females aged 3-20 years and presented with growth failure and skeletal deformities. All had florid clinical and radiological rickets. The biochemical abnormalities seen included hypocalcaemia, hypophosphataemia, and hyperphosphatasia. All patients had grossly raised 25-hydroxyvitamin D concentrations and markedly low to undetectable concentrations of 1,25-dihydroxyvitamin D. A disturbing feature of this study was the late referral of the patients.     

Congestive heart failure caused by vitamin D deficiency?

We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia.