Calcitriol has been widely used in the management of osteoporosis, but its efficiency is a matter of controversy. It is not known whether combinations of calcitriol and antiresorptive agents such as etidronate and calcitonin are superior to calcitriol alone in the treatment of postmenopausal osteoporosis. To make this determination, 30 Turkish women with postmenopausal osteoporosis between 45 and 68 years of age were randomized to receive either intermittent cyclical etidronate (400 mg/day, for 14 days) followed by 60 days of cyclical calcitriol therapy 0.25 microg twice daily (group 1; n = 10), or calcitriol 0.25 microg twice daily (group 2; n = 10), or calcitriol 0.25 microg/day in combination with 100 IU intranasal salmon calcitonin taken every other day (group 3; n = 10) through a 1-year period. Bone mineral density (BMD) of lumbar spine (L2 to L4) was determined for each patient by dual-photon absorptiometry (153Gd) at baseline, after 6 months, and at the end of the study. There was no significant difference among groups with respect to mean spinal BMD at baseline, after 6, and after 12 months. No significant spinal BMD changes occurred in any group from baseline, after 6 months, and after 12 months. Four patients in groups 1 and 2 and five patients in group 3 developed hypercalcemia at least once during therapy. Hypercalciuria occurred at least once in 9, 10, and 7 patients in groups 1, 2, and 3, respectively. One patient in group 2 developed a renal stone at the end of the study. Mean urine hydroxyproline levels did not change significantly in any group with respect to baseline. The data suggest that one-year treatment with calcitriol, given either alone or in combination with antiresorptive agents, does not improve spinal BMD in Turkish women with postmenopausal osteoporosis, and is associated with a high rate of adverse events.

译文

骨化三醇已被广泛用于骨质疏松症的治疗,但其有效性尚有争议。在绝经后骨质疏松症的治疗中,骨化三醇和抗再吸收剂(如依替膦酸酯和降钙素)的组合是否优于单独的骨化三醇尚不清楚。为了确定这一点,将30例年龄在45至68岁之间的绝经后骨质疏松症的土耳其妇女随机接受间歇性周期性依替膦酸治疗(400 mg /天,持续14天),然后接受60天周期性钙三醇治疗,每天两次,每次0.25 microg(组) 1; n = 10),或每天两次两次钙钙三醇0.25微克(组2; n = 10),或每隔一天服用100 IU鼻内鲑降钙素与钙三醇0.25微克/天组合(组3; n = 10),通过1年期限。在基线,6个月后和研究结束时,通过双光子吸收法(153Gd)为每位患者确定腰椎(L2至L4)的骨密度(BMD)。各组之间在基线,6个月后和12个月后的平均脊柱骨密度没有显着差异。从基线,6个月和12个月后的任何组中,没有明显的脊柱BMD变化发生。在治疗期间,第1组和第2组的4名患者和第3组的5名患者至少发生一次高钙血症。高钙尿症分别在第1、2和3组的9、10和7名患者中至少发生一次。在研究结束时,第2组的一名患者出现了肾结石。相对于基线,平均尿羟脯氨酸水平在任何组中均无显着变化。数据表明,单独或与抗吸收药联合使用骨化三醇治疗一年并不能改善绝经后骨质疏松症的土耳其妇女的脊柱BMD,并且不良反应发生率较高。

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