Calcitriol treatment in metabolic bone disease of prematurity with elevated parathyroid hormone: A preliminary study.
JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014;
2:14-20. [PMID:
29159104 PMCID:
PMC5685017 DOI:
10.1016/j.jcte.2014.12.001]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 12/03/2022]
Abstract
Objective
To describe the association of calcitriol treatment with the change in parathyroid hormone (PTH) and biochemical markers of bone disease in infants with metabolic bone disease of prematurity (MBD) and secondary hyperparathyroidism.
Study design
This retrospective chart review examined serum intact PTH, serum calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (APA), urine calcium/creatinine (UCa/Cr), and tubular reabsorption of phosphate (TRP) in 32 infants prior to and following calcitriol treatment for MBD with PTH >100 pg/ml. 25-hydroxyvitamin D concentrations were recorded.
Results
Following calcitriol treatment, PTH decreased from median (min/max) 220 (115/593) to 25 (3/259) pg/ml, p < 0.001; Ca increased from 9.9 (8.9/10.7) to 10.3 (9.7/11.3) mg/dl, p < 0.001; P increased from 4.3 (2.7/6.4) to 5.4 (2.9/7.4) mg/dl, p = 0.001; and TRP increased from 81 (59/98) to 91.5 (78/98) %, p = 0.03. APA did not differ pre-treatment: 616 (209/1193) vs. post-treatment 485 (196/1229) U/L, p = 0.12. Vitamin D deficiency was not present. Hypercalcemia with hypercalciuria occurred in 3/32 subjects, all normalized after dose reduction.
Conclusion
Improvements in MBD markers and lack of serious adverse effects suggest calcitriol may be a treatment option in infants with MBD and secondary hyperparathyroidism.
Calcitriol was associated with improvement in several MBD-related metabolic parameters
PTH and TRP may be useful in evaluating MBD in neonates with intestinal compromise
Markers of MBD were not different in early MBD vs MBD associated with fracture
Collapse