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Reduction of falls and osteoporotic fractures: Plain vitamin D or D‐hormone analogs?
Author(s) -
Schacht Erich
Publication year - 2008
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/j.1447-0594.2007.00400.x
Subject(s) - calcitriol , medicine , vitamin d and neurology , alfacalcidol , calcitriol receptor , endocrinology , osteoporosis , hormone , parathyroid hormone , vitamin d deficiency , calcium , bone mineral
Falling in old age has disastrous consequences. Falls break bones, self‐esteem and activity. Fractures are also the relevant outcome of osteoporosis. D‐hormone (1,25[OH] 2 D; calcitriol), and its receptor (VDR) play an important role in muscle development. Older age is significantly associated with decreased VDR expression in human skeletal muscle tissue. A positive correlation was found between femoral muscle power and function and D‐hormone serum levels in the elderly. These results suggest that the age‐related increase of falls seemed in part to be explained by a decrease of VDR and of D‐hormone. A significant decrease in the fall rate after 3 years treatment with 0.5 μg calcitriol daily in osteopenic women without vitamin D deficiency has been described. Alfacalcidol, an advantageous pro‐drug of calcitriol, has demonstrated the reduction of falls by 50–70% in elderly women and men with normal vitamin D levels in serum and who have taken more than 500 mg of daily calcium from diet or had a creatinine clearance of less than 65 mL/min. A meta‐analysis of the potential effects of plain vitamin D and D‐hormones was published. Subgroup analyses have proven the clear advantage of D‐hormones. In addition, three recently published confirmative clinical studies in elderly people with or without previous osteoporotic fractures have shown that neither an annual injection of 300 000 IU of plain vitamin D nor the combination of daily orally given vitamin D (800 IU) with calcium (1 g) is able to reduce falls or any kind of fractures. New meta‐analyses with D‐hormones have proven the reduction of vertebral and non‐vertebral fractures in women with postmenopausal osteoporosis. The rationale of the advantage of D‐hormones is that these drugs act without metabolic activation in the kidney which results in higher concentrations at the target organs and in local expression of VDR. Plain vitamin D seemed to be active only in vitamin D deficient patients with normal kidney function.