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The clinical use of vitamin D metabolites and their potential developments: a position statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF)

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Abstract

Several compounds are produced along the complex pathways of vitamin D3 metabolism, and synthetic analogs have been generated to improve kinetics and/or vitamin D receptor activation. These metabolites display different chemical properties with respect to the parental or native vitamin D3, i.e., cholecalciferol, which has been, so far, the supplement most employed in the treatment of vitamin D inadequacy. Hydrophilic properties of vitamin D3 derivatives facilitate their intestinal absorption and their manageability in the case of intoxication because of the shorter half-life. Calcidiol is a more hydrophilic compound than parental vitamin D3. Active vitamin D analogs, capable of binding the vitamin D receptor evoking vitamin D-related biological effects, are mandatorily employed in hypoparathyroidism and kidney failure with impaired 1α-hydroxylation. They have been shown to increase BMD, supposedly ameliorating calcium absorption and/or directly affecting bone cells, although their use in these conditions is jeopardized by the development of hypercalciuria and mild hypercalcemia. Further studies are needed to assess their overall safety and effectiveness in the long-term and new intermittent regimens, especially when combined with the most effective antifracture agents.

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Acknowledgments

This paper was derived from a Working Group meeting supported by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

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Authors and Affiliations

  1. Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy

    Luisella Cianferotti & Maria Luisa Brandi

  2. Italian College of General Practitioners, Florence, Italy

    Claudio Cricelli

  3. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

    John A. Kanis

  4. Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

    Ranuccio Nuti

  5. Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart-Tilman, Liège, Belgium

    Jean-Y. Reginster

  6. Department of General Internal Medicine, Klinikum Leverkusen University of Cologne, Cologne, Germany

    Johann D. Ringe

  7. Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    Rene Rizzoli

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  1. Luisella Cianferotti
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Cianferotti, L., Cricelli, C., Kanis, J.A. et al. The clinical use of vitamin D metabolites and their potential developments: a position statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF). Endocrine 50, 12–26 (2015). https://doi.org/10.1007/s12020-015-0606-x

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