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Secondary Hyperparathyroidism Due to Hypovitaminosis D Affects Bone Mineral Density Response to Alendronate in Elderly Women with Osteoporosis: A Randomized Controlled Trial
Author(s) -
Barone Antonella,
Giusti Andrea,
Pioli Giulio,
Girasole Giuseppe,
Razzano Monica,
Pizzonia Monica,
Palummeri Ernesto,
Bianchi Gerolamo
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01161.x
Subject(s) - medicine , bone mineral , femoral neck , osteoporosis , randomized controlled trial , vitamin d and neurology , secondary hyperparathyroidism , urology , bone density , hyperparathyroidism , vitamin d deficiency , calcitriol , parathyroid hormone , calcium
OBJECTIVES: To determine whether secondary hyperparathyroidism (HPTH) due to hypovitaminosis D affects bone mineral density (BMD) response to alendronate (ALN) in elderly women with osteoporosis. DESIGN: Randomized, controlled trial with 1‐year follow‐up. SETTING: Two osteoporosis centers in northern Italy. PARTICIPANTS: Community‐dwelling women aged 60 and older with a BMD T‐score below –2.5 and secondary HPTH with vitamin D insufficiency. INTERVENTION: One hundred twenty subjects were randomly assigned to receive ALN 70 mg once a week alone or ALN 70 mg once a week plus calcitriol (1,25D3) 0.5 μg daily. MEASUREMENTS: BMD measured using dual‐energy x‐ray absorptiometry at the lumbar spine (L1‐L4), femoral neck, and total hip and serum levels of intact PTH at baseline and 12 months. RESULTS: After 1 year, BMD of the lumbar spine, femoral neck, and total hip significantly increased from baseline in both groups ( P <.001). Patients allocated to ALN plus 1,25D3 demonstrated a significantly higher increase in lumbar spine BMD than those receiving ALN alone (mean percentage±standard deviation 6.8±4.6 vs 3.7±3.2, P <.001). Serum levels of PTH did not change significantly at 1 year in the ALN group (mean percentage, −3.7±27.1, P =.13) but decreased significantly in the ALN plus 1,25D3 group (−32.1±22.1, P <.001). At 12 months, subjects with normalized PTH independent of therapy allocation had a greater increase in lumbar spine BMD than those with persistent HPTH (6.5±4.6% vs 3.7±3.4%, P <.001). Lumbar spine BMD changes showed a significant negative correlation with PTH at 1 year (correlation coefficient ( ρ ) =−0.399, P <.001) and a positive correlation with PTH changes (i.e., baseline value – 1 year value; ρ =0.295, P =.005). CONCLUSION: Persistence of secondary HPTH reduces BMD response to ALN in older women with osteoporosis.