Bone Mass and Markers of Bone and Calcium Metabolism in Postmenopausal Women Treated with 1,25-Dihydroxyvitamin D (Calcitriol) for Four Years

To evaluate the long-term effect of calcitriol treatment on bone mineral density (BMD) of the femoral neck and lumbar spine and the parameters of calcium and bone metabolism in elderly women, 55 healthy, postmenopausal women, all aged 66 years, were enrolled in the study. Eighteen started a 4-year supplementation with 0.5 μg of calcitriol daily and 37 served as controls. Calcium intake of all the subjects was adjusted to 800 mg daily. In 4 years femoral neck BMD increased by 3.0% in the calcitriol group, but decreased by 1.6% in the control group (P= 0.009). The respective changes in lumbar spine BMD were +2.3% and +0.9% (P= 0.067). Two years' treatment with calcitriol increased the intestinal absorption of strontium by 57% (P < 0.001), doubled the urinary excretion of calcium (P < 0.001), and decreased the mean parathyroid hormone (PTH) level by 32% (P < 0.01). In the calcitriol group the marker of bone formation, serum osteocalcin, decreased by 27% (P < 0.01), and the marker of bone resorption, serum C-telopeptide of type I collagen (CTx), by 33% (P= 0.05) after 2 years. In two subjects the calcitriol dose had to be reduced because of hypercalciuria. We conclude that calcitriol treatment increases bone mass at the femoral neck and lumbar spine, the increases being maintained for up to 4 years. The gain in bone mass results from reduced bone turnover which is partly a consequence of the enhanced intestinal absorption of calcium and suppressed serum PTH levels. Received: 8 January 1999 / Accepted: 29 February 2000     

A Comparison of Continuous Alendronate, Cyclical Alendronate and Cyclical Etidronate with Calcitriol in the Treatment of Postmenopausal Vertebral Osteoporosis: A Randomized Controlled Trial

A number of drugs are now available for the treatment of established osteoporosis and have been shown to significantly increase bone mineral density (BMD). There are, however, few comparative treatment studies and, furthermore, adverse events remain a problem with some of the newer agents, particularly in the elderly, in everyday clinical practice. We report a 12 month, open labeled, randomized controlled, prospective treatment study in 140 postmenopausal women with established vertebral osteoporosis, comparing the effect of continuous alendronate, cyclical alendronate and cyclical etidronate with calcitriol in terms of gain in BMD, reduction in bone turnover markers and adverse event profile. The mean percentage increases in BMD at 12 months, at the spine and hip respectively, were: continuous alendronate 5.7%, 2.6%; cyclical alendronate 4.1%, 1.6%; cyclical etidronate 4.9%, 2.0% (p<0.01) and calcitriol 2.0%, 0.4% (NS). In comparison with calcitriol, the mean changes in BMD at the spine and hip respectively were greater in the other groups; continuous alendronate: 3.7% (95% CI 1.4 to 8.3), 2.2% (95% CI 0.7 to 4.0); cyclical alendronate: 2.1% (95% CI 1.2 to 6.4), 1.2% (95% CI −0.3 to 3.0); cyclical etidronate: 2.9% (95% CI 1.9 to 6.5), 1.6% (95% CI 0.9 to 3.1)). The reduction in bone turnover markers was between 26% and 32% in the alendronate and etidronate groups (p<0.01), with a trend toward greater reduction in the continuous alendronate group. Eight patients discontinued the study: 6 in the continuous alendronate group, 1 in the cyclical alendronate group and 1 in the calcitriol group. Two patients in the cyclical etidronate group were unable to tolerate the Cacit component, but continued on substituting Cacit with Calcichew. In summary, 12 months of treatment with continuous alendronate, cyclical alendronate and cyclical etidronate are effective in terms of the gain in BMD at the anteroposterior spine and total hip in a comparable treatment population. These treatments are more effective than calcitriol and were generally well tolerated. Continuous alendronate showed a trend toward a larger gain in BMD and greater suppression of bone turnover markers than the other treatment groups, but had a higher incidence of adverse events, particularly within the older subgroup. Cyclical alendronate offers a lower adverse event profile and appears to be effective in comparison with continuous treatment, and may possibly be an alternative in the elderly. However, further studies are necessary, but more importantly with fracture end-points. Received: 6 April 1999 / Accepted: 8 June 2000     

绝经后妇女骨密度与血清1，25-（OH）2D3，25-OHD3浓度关系的研究

目的：研究绝经后妇女无优势手臂骨密度与血清1,25-（OH）2D3,25-OHD3含量的关系。方法：采用定量超声骨量分析系统（QUS）测量82例绝经后妇女无优势前臂远端骨密度（BMD）以诊断骨质疏松,采用放射免疫法（RIA）和ELISA检测骨质疏松组和骨量正常组妇女血清中1,25-（OH）2D3,25-OHD3水平。结果：绝经后骨质疏松组妇女血清1,25-（OH）2D3,25-OHD3含量分别为（26.97±6.78）pg/ml和（34.75±12.62）nmol/L,骨量正常组分别为（34.75±12.62）pg/ml和（42.03±12.63）nmol/L,骨质疏松妇女血清1,25-（OH）2D3、25-OHD3含量明显低于骨量正常组（P〈0.01）。绝经后妇女无优势前臂骨密度与血清1,25-（OH）2D3含量存在明显相关性（r=0.387,P=0.001）,25-OHD3含量与前臂骨密度也存在相关性。结论：血清1,25-（OH）2D3水平与无优势前臂骨密度明显相关,是绝经后妇女骨量降低的重要原因之一。     

双骨三子胶囊联合骨化三醇治疗女性绝经后骨质疏松性髋部骨折的临床研究

目的 探讨双骨三子胶囊联合骨化三醇治疗女性绝经后骨质疏松性髋部骨折的临床效果。方法 选取2018年3月—2021年3月许昌仁和骨伤医院收治的128例绝经后骨质疏松性髋部骨折患者,随机分成对照组和治疗组,每组各64例。对照组口服骨化三醇软胶囊,1粒/次,2次/d。治疗组在对照组基础上口服双骨三子胶囊,3粒/次,3次/d。两组均连续治疗6个月。观察两组患者临床疗效,比较治疗前后两组患者骨折临床愈合时间,疼痛视觉模拟量表（VAS）评分,36项健康调查简表（SF-36）总分,腰椎正位和髋部的骨密度（BMD）,尿钙与尿肌酐比值（U-Ca/Cr）和血清I型前胶原N端前肽（P1NP）、I型胶原羧基末端肽β特殊序列（β-CTX）、白细胞介素（IL）-6水平。结果 治疗后,治疗组临床有效率为93.75%,显著高于对照组的78.12%(P<0.05)。与对照组相比,治疗组骨折临床愈合时间显著缩短（P<0.05）。治疗后,两组疼痛VAS评分均显著降低,而SF-36总分则均显著升高（P<0.05）,且治疗组改善更显著（P<0.05）。治疗后,两组腰椎正位和髋部的BMD较治疗前均显著增加...     

胃癌及其癌旁黏膜中维生素D受体的表达

目的探讨胃癌组织中维生素D受体(VDR)的表达,并与癌旁正常胃黏膜组织比较。方法采用免疫组化方法,检测75例胃癌组织和癌旁正常胃黏膜组织中VDR表达。结果胃癌组织中VDR表达显著低于正常胃黏膜(P<0.05)。癌组织中VDR的表达在不同年龄、性别、TNM分期、组织学分型、浸润深度、淋巴结转移之间差异无统计学意义。VDR表达与癌组织分化程度有关,高、中、低分化3组VDR表达依次降低,且差异有统计学意义(P<0.05)。结论 VDR表达可以作为判断胃癌分化程度的依据之一。     

骨化三醇干预骨质疏松对高脂血症患者血管钙化的影响

目的:观察骨化三醇干预骨质疏松对高脂血症患者血管钙化的影响。方法:选取160例高脂血症患者。随机分为两组:A组对照组,阿托伐他汀组80例,B组试验组,阿托伐他汀+骨化三醇组80例。分别测定颈动脉斑块的人数及厚度、心脏瓣膜钙化的人数、baPWV的数值。结果:试验组抑制了颈动脉钙化、心脏瓣膜钙化过程;用药后试验组患者的颈动脉斑厚度减小,与对照组相比,差异有统计学意义(P<0.05)。结论:骨化三醇对血管钙化有明显的抑制作用。     

慢性肾脏病甲状旁腺素与贫血的相关性研究

目的：探讨慢性肾脏病（ CKD ）甲状旁腺素（ PTH ）与肾性贫血的关系。方法测定126例CKD3～5期患者血PTH、血红蛋白（ Hb）、红细胞比容（ Hct）、尿素氮（ BUN）、肌酐（ Cr）水平及维持性血液透析（MHD）患者42例经重组人促红细胞生成素（rhEPO）、骨化三醇-1．25（OH）2D3治疗3个月后变化。结果CKD3期PTH明显升高,CKD4期、CKD5期升高更显著;血PTH与BUN、Cr呈线性正相关（P＜0．01）,与内生肌酐清除率（Ccr）、Hb呈线性负相关（P＜0．01）。 MHD患者经rhEPO、1．25（OH）2D3治疗3个月后,根据Hct变化,治疗有效73．8％,无效26．2％。有效组与无效组比较PTH、Hb、Hct差异均有统计学意义（P＜0．01）,且PTH下降,Hb、Hct升高。结论 CKD患者随着肾功能下降,血PTH升高。高PTH血症加重肾性贫血且使EPO疗效差,1．25（OH）2D3能降低高PTH血症,随高PTH血症的纠正,肾性贫血得到改善。     

骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者的影响

目的探讨骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者血甲状旁腺激素（PTH）、钙、磷水平的影响。方法将22例维持性血液透析继发性甲状旁腺功能亢进患者进行长时血液透析治疗,3次／周,每次6h。同时口服骨化三醇1I,zg／次,3次／周,共治疗3个月。分别于治疗前和治疗后检测血PTH、钙及磷水平。结果患者治疗后血PTH和血磷较治疗前明显下降[（484．21±230．18）nmol／L比（750．53±327．41）nmol／L、（1．49±0．27）mmol/L比（2．37±0．76）mmol／L],血钙较治疗前明显上升[（2．35±0．32）mmol／L比（1．81±0．53）mmol／L],差异均有统计学意义（P〈0．05）。结论骨化三醇联合长时血液透析可以降低维持性血液透析继发性甲状旁腺功能亢进患者血磷及血PTH,升高血钙,对治疗维持性血液透析继发性甲状旁腺功能亢进有一定的疗效。     

Hypovitaminosis D Is Associated with Higher Levels of Inflammatory Cytokines and with HAM/TSP in HTLV-Infected Patients

Recent studies have shown the effects of vitamin D on host response to infectious diseases. Some studies detected a high prevalence of hypovitaminosis D in HIV-infected patients, but scarce information exists for HTLV-1 infection. We conducted a cross-sectional study to evaluate the frequency of hypovitaminosis D in HTLV-1 patients and its relationship with their immune response in HTLV-infected patients and in age- and gender-matched controls at a Brazilian rehabilitation hospital. We compared vitamin D, interleukin-6 (IL-6), tumoral necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) levels across groups. Logistic regression was utilized to assess the association between hypovitaminosis D and cytokine levels. We enrolled 161 HTLV-infected subjects (129 HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients, 32 asymptomatic HTLV carriers) and equal number of HTLV-negative controls. We observed a significantly higher prevalence of hypovitaminosis D in patients with HAM/TSP than in HTLV asymptomatic carriers (p < 0.001), or controls (p < 0.001). HAM/TSP patients also had higher levels of IL-6 and IFN-γ than asymptomatic carriers. Patients with HAM/TSP and hypovitaminosis D had higher levels of TNF-α than asymptomatic HTLV carriers. These findings suggest hypovitaminosis D plays a role in HAM/TSP pathogenesis, and it needs to be evaluated in further studies.     

Treatment of alopecia totalis/universalis/focalis with vitamin D and analogs: Three case reports and a literature review

BACKGROUNDAlopecia areata (AA) is an inflammatory disease with autoimmune, environmental, and inherited components directed at the hair follicle, either limited to patchy hair loss over the scalp (Focalis, AF), total loss of scalp hair (Totalis, AT), or total loss of both scalp and body hair (Universalis, AU). Despite multiple treatment modalities, no therapy exists. Vitamin D deficiency in patients with AA/AT/AF influences disease severity and duration, inversely correlating with inflammation histologically.CASE SUMMARYThree girls presented with AT (P1), AU (P2), and AF (P3) at the ages of 1, 5, and 5 years, respectively. For P1-P2, all available treatments implemented for 2 years had failed. We started an initial 6-mo repletion with oral cholecalciferol 2000/4000 IU/d, with no apparent effect. Then we attempted immunomodulation using oral calcitriol and its analog paricalcitol. On calcitriol, 0.5 mcg/d P1 regrew hair within 6 mo. After 4 years, a relapse with loss of eyebrow hair was resolved after doubling the calcitriol dose to 0.5 mcg × 2/d; the results have been maintained for 6 years to date. On calcitriol, 0.25 mcg × 3/d P2 led to the development of asymptomatic hypercalcemia-hypercalciuria, which was immediately resolved by switching to paricalcitol 2 mcg × 3/d; mild tolerable hypercalciuria was maintained. Hair regrowth was observed at 6 mo, stabilizing only as fur at 12 mo. AF in P3 was resolved completely within 3 mo on a daily high dose (8000 IU) of cholecalciferol.CONCLUSIONVitamin D may have immunomodulating therapeutic impact on AT/AU/AF, which needs to be explored with further pilot clinical trials.