Role of calcitriol in prevention of osteoporosis: Part I

Seasonal interaction of serum vitamin D concentration and bone density in alpacas

OBJECTIVE

To evaluate temporal changes in bone mineral density associated with seasonal variation in serum vitamin D, calcium, and phosphorus concentrations in alpacas.

ANIMALS

5 healthy mature neutered male alpacas.

PROCEDURE

Metacarpal bone mineral density was measured at 4 times during a year. Each time alpacas were weighed, blood was collected for determination of serum calcium, phosphorus, and vitamin D concentrations, and samples of feed were analyzed for nutrient content. Vitamin D status was determined by use of an assay that measured serum 25-hydroxycalciferol concentration. Effects of changes in serum vitamin D, calcium, and phosphorus concentration and body weight with season on bone mineral density were determined.

RESULTS

Bone mineral density, body weight, and serum vitamin D and phosphorus concentrations varied with season. Bone mineral density, serum vitamin D concentration, and body weight also varied among individual alpacas. Serum vitamin D concentration was lower in January than the previous October and increased from May to the following September. The decrease in bone mineral density lagged behind the decrease in serum vitamin D concentration and was lower in May, compared with the previous October. Body weight was lower in May than the previous October or following September. Solar radiation was highest in July and lowest in December.

CONCLUSIONS AND CLINICAL RELEVANCE

Seasonal changes in bone mineral density are associated with changes in serum vitamin D concentrations in alpacas. Changes in bone mineral density associated with a decline in serum vitamin D concentration may predispose some alpacas to developing fractures minimal trauma.

Novel therapeutic targets in osteoporosis

Osteoporosis is a common condition in which significant bone loss occurs resulting in an increased risk of sustaining fractures. Several licensed therapies are available to treat this condition, which suffer from several disadvantages including limited efficacy, high cost and poor long-term patient adherence as a consequence of significant side effects and inconvenient methods of administration. A wide range of therapeutic targets have been developed to provide a basis for developing newer therapies which overcome these limitations. These can be subdivided into those that are primarily directed towards inhibiting osteoclast-dependent bone resorption and those that stimulate osteoblastic bone formation. Targets can be grouped as follows: systemic factors such as steroid and peptide hormones; local factors produced in bone involved in osteoblast and osteoclastic regulation; and cellular targets such as cell membrane receptors and attachment proteins, cellular enzymes and nuclear transcription factors. To date, only a small proportion of these targets have yielded novel compounds to have entered clinical trials. However, it is anticipated that these will provide the basis for significant numbers of new therapies for osteoporosis in the foreseeable future.

The use of dual-energy x-ray absorptiometry in animals

The use of dual-energy absorptiometry (DXA) to measure bone mineral content (BMC) and bone mineral density (BMD) is widespread in humans and has been adapted to animals because of the need to examine bone and body composition in longitudinal studies. In this review, the indications and techniques for DXA in small-sized animals (rodents, cats, and rabbits) and large-sized animals (dogs, swine, nonhuman primates, sheep, and horses) are discussed. Now that software has been developed for measuring BMD in small laboratory animals, the most frequent use of DXA in animals is in rats. An ultrahigh-resolution mode of acquisition is used for their small bones but also is necessary for other small-sized animals such as rabbits and cats. In larger-sized animals such as dogs, pigs, and sheep, software used in humans has been adapted successfully to measure BMC/BMD and body composition. The human spine and left and right hip protocols are adapted easily to animals of this size, and the software for body composition has been adapted to dogs. Measurement of bone mass around metallic implants is possible in animals and most studies have involved dogs. To ensure precision of DXA in the noninvasive measurement of BMD in animals, attention to positioning and ability of the operator to define the same region of interest using clearly defined anatomical landmarks on the scan image cannot be overemphasized. This is one of the essential requirements for successful densitometry in animals.

Dual-energy X-ray absorptiometry in sheep: experiences with in vivo and ex vivo studies

As different large animal models of osteopenia and osteoporosis are explored, the use of DXA to rapidly, non-invasively and accurately estimate BMD will become widespread. We used DXA in live sheep and cadaveric material and the areas of trabecular bone that are most accessible on a simple, repeatable basis in the sheep were the lumbar vertebrae (L4-L6/L5-L7), the CAL and the DR. We performed dual-energy X-ray absorptiometry (DXA) using an Hologic QDR 1000-W bone densitometer to measure bone mineral density (BMD) at various regions of interest in anesthetized sheep and cadaveric specimens of sheep. In vivo measurements of L4-L6/L5-L7, the calcaneus (CAL) and distal radius (DR) in 48 intact 3 to 5-year-old ewes (same breed) were performed. Correlations between the different bones were investigated. In an in vivo precision study, BMD of L3-L6/L7, CAL and DR was determined with one animal repositioned between 10 scans of each bone. In another study, ex-vivo BMD measurements of the proximal and distal femur, proximal tibia, and proximal humerus were performed on isolated bones of 45 ewes of similar age. Excised vertebrae were scanned on the Hologic QDR 1000-W and on a Lunar DPX (at another site) and the data were compared. Correlations of BMD between individual vertebrae in anesthetized sheep were excellent (r = 0.944- 0.843; P < 0.0001). Correlation between BMD of individual vertebrae and CAL was good (r = 0.677-0.630), while correlation between BMD of individual vertebrae and DR was also good (r = 0.551-0.507; P < .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol. A review of its use in the treatment of postmenopausal osteoporosis and its potential in corticosteroid-induced osteoporosis

A synthetic form of calcitriol (1,25-dihydroxycholecalciferol; 1,25-dihydroxyvitamin D3), the most physiologically active metabolite of vitamin D, has shown efficacy in the treatment of postmenopausal osteoporosis and promise in corticosteroid-induced osteoporosis. Although results of small studies investigating calcitriol in the treatment of postmenopausal osteoporosis have been conflicting, a clinical trial in 622 women with postmenopausal osteoporosis demonstrated that patients with mild to moderate disease who received calcitriol (0.25 microgram twice daily) had a significant 3-fold lower rate of new vertebral fractures after 3 years of treatment, compared with patients receiving elemental calcium 1000 mg/day. In patients commencing long term treatment with prednisone or prednisolone, calcitriol 0.5 to 1.0 micrograms/day plus calcium 1000 mg/day, administered with or without intranasal calcitonin 400 IU/day, prevented steroid-induced bone loss. Overall, calcitriol is well tolerated. As shown in clinical studies, at recommended dosages hypercalcaemia is infrequent and mild, generally responding to reductions in calcium intake and/or calcitriol dosage. The narrow 'therapeutic window' of calcitriol requires that its use be adequately supervised, with periodic monitoring of serum calcium and creatinine levels. However, significant renal toxicity has not been seen in patients with osteoporosis treated with calcitriol in high dosages for several years in comparative and noncomparative trials. In conclusion, as with other drugs currently used in the management of patients with osteoporosis, questions remain to be answered regarding the efficacy of calcitriol relative to other agents, and its tolerability in such patients during the very long term. Nonetheless, at this stage, calcitriol should be considered a useful treatment option in patients with mild to moderate postmenopausal osteoporosis.

Evaluation of the skeletal effects of combined mild dietary calcium restriction and ovariectomy in Sinclair S-1 minipigs: a pilot study

A pilot study was conducted to investigate the combined effects of ovariectomy (OVX) with preceding and concomitant mild dietary calcium restriction on the minipig skeleton. Minipigs 4 months old were fed diets containing 0.9, 0.75, or 0.5% calcium (Ca). At 10 months, the 0.75 and 0.5% pigs were OVX and the 0.9% were either sham operated or OVX. All pigs were maintained on their respective diets for an additional 6 months. Excised lumbar vertebrae and long bones were evaluated by densitometry and histomorphometry, and vertebral cancellous bone samples were tested biomechanically. In pigs fed the 0.9% Ca diet, OVX alone effected decreases of 6% in vertebral bone mineral density (BMD), 15% in trabecular bone volume (BV/TV), and 13% in trabecular number (Tb.N), an increase of 15% in trabecular separation (Tb.Sp), and a nonsignificant increase (p < 0.056) in vertebral cancellous final erosion depth (F.E.De) compared with the 0.9% Ca sham-operated group. Decreasing dietary Ca to 0.5% in combination with OVX effected an 8% reduction in vertebral BMD that was not associated with any significant alterations in parameters of vertebral cancellous bone microstructure or remodeling compared with the 0.9% Ca sham-operated pigs. Increases in serum PTH noted in the 0.5% Ca OVX group were generally paralleled by increases in calcitriol. In OVX pigs fed a diet containing 0.75% Ca, a 10% reduction in vertebral BMD was observed. This was associated with significant increases in F.E.De and vertebral marrow star volume (Ma.St.V) compared with the 0.9% Ca sham-operated pigs and the other OVX groups. In addition, Tb.Sp was increased and Tb.N decreased compared with the 0.9% Ca sham-operated pigs. Increases in serum PTH in this group were not accompanied by increases in calcitriol. Midradial and midfemoral BMD values were reduced in the 0.75 and 0.5% Ca OVX groups compared with the 0.9% Ca sham-operated pigs. Histomorphometric analyses of cortical bone suggested the reduction in cortical bone mass in the 0.75% Ca OVX group may have been largely due to net loss on the endocortical surface versus possible failure to accrue bone in the 0.5% Ca OVX group. Ash density and biomechanical parameters for vertebral cancellous bone decreased progressively in the 0.9% sham-operated, 0.9% Ca OVX, and 0.75% Ca OVX groups and then increased in the 0.5% Ca OVX group. After normalization for bone mass (ash), mechanical changes were still apparent, particularly for the 0.75% Ca OVX group compared with other OVX groups, reflecting that structural changes had taken place in the trabecular network.(ABSTRACT TRUNCATED AT 400 WORDS)

Sequential and precise in vivo measurement of bone mineral density in rats using dual-energy x-ray absorptiometry

In the design of new strategies for the treatment of osteoporosis, noninvasive, precise, and sensitive bone mass measurement capable of detecting changes over short periods of time in small animals is essential. Most of the models described thus far require the sacrifice of the animals and/or display low reproducibility. Using a dual-energy x-ray absorptiometer (DEXA; Hologic QDR-1000) in an ultrahigh-resolution mode, we measured bone mineral density (BMD) in rats at the levels of lumbar spine (L1-4), proximal tail (caudal vertebrae C2-4), and tibia. Accuracy was evaluated by measuring the mineral content of bone powder capsules (within the range of rat vertebrae BMD), under 0.5-3 cm water to mimic variations in soft tissue thickness. The bone powder capsule mineral content was highly correlated with chemically determined hydroxyapatite content (r = 0.999). In vivo reproducibility was evaluated by calculating the coefficient of variation (CV = 100 x SD/mean) of four to six BMD measurements, each time with repositioning, in seven rats (220-500 g body weight). CV was 1.36 +/- 0.32% (x +/- SD) for lumbar spine, 0.66 +/- 0.50% for proximal tail, and 1.12 +/- 0.45% for tibia. The ability to detect BMD changes was investigated by measuring BMD before and every 4 weeks after ovariectomy (OVX) in 270 g rats, pair fed during the whole experiment. Compared with sham-operated control animals, a highly significant difference in lumbar spine BMD was observed 4 weeks after OVX, which reached a maximum by 8 weeks and remained stable thereafter. At the level of the proximal tibia, the difference was maximal 4 weeks after OVX.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of changes in histomorphometric, bone mass, and biochemical parameters in ovariohysterectomized dogs

A predictable animal model with skeletal remodeling characteristics similar to those of humans is needed to facilitate the understanding of the mechanism of postmenopausal osteoporosis. We have utilized the ovariohysterectomized (Ovh) dog to examine cellular and biochemical responses to estrogen depletion and PTH stimulation. Histomorphometric measurements of bone biopsies taken prior to (first biopsy) and five months after the operation (second biopsy) showed no significant differences in static and dynamic parameters. Bone mineral density of the excised vertebrae displayed the same values between the two groups six months after surgery. Between the second biopsy and sacrifice, two infusion studies were performed. A two-hour infusion of EDTA followed by a two-hour recovery period elicited a rapid response in PTH production, highly correlated to the changes in ionized calcium, but no significant difference in response was observed between Sham and Ovh groups. A short-term (24-h) infusion of 1-34 hPTH increased circulating ionized calcium and 1,25-(OH)2-D levels to a similar extent in both groups. The levels of alkaline phosphatase were constant and both groups showed a small but nonsignificant increase in osteocalcin. The lack of sizable responses in histomorphometric, bone mass, and biochemical parameters may limit the utility of dogs for the study of cancellous bone loss in ovarian-dysfunction osteoporosis.