Abstract
Due to pleiotropic-synergistic actions on bone, muscle, gut, brain and different other non-skeletal tissues, alfacalcidol is an interesting drug for treating osteoporosis. In studies on glucocorticoid-induced osteoporosis, men have always been treated with calcitriol or this active D-hormone prodrug, but there is no study of male patients only in the literature. The AIM-Trial (Alfacalcidol In Men) is an extension of the control group (n = 158) of our former risedronate study in male osteoporosis (Ringe et al. in Rheumatol Int 29:311–315, 2009). In that study, we treated daily those controls with prevalent vertebral fractures with 1 μg alfacalcidol + 500 mg calcium (group A) and those without prevalent vertebral fractures with 1,000 IU plain vitamin D (Vit. D) + 1,000 mg calcium (group B). Subsequently, we added an additional 56 pairs of patients to these two groups: 28 with and 28 without prevalent vertebral fractures, reaching a total of 214 cases. That means with this design, we are comparing two groups with a different risk at onset. Due to the prevalent vertebral fractures and lower average bone mineral density (BMD) values, there was a higher risk of incident fractures in group A. After 2 years, we found significantly higher increases in lumbar spine BMD (+3.2 vs. +0.8 %) and total hip BMD (+1.9 vs. −0.9 %) in group A and B, respectively. Eighteen incident falls were recorded in the alfacalcidol group and 38 in the group treated with Vit. D (p = 0.041). There were significantly lower rates of patients with new vertebral and non-vertebral fractures in group A than in group B. Back pain was significantly reduced only with alfacalcidol. Concerning the incidence of new non-vertebral fractures, we found that there was a relation to renal function in the two groups. The advantage for alfacalcidol was mainly due to a higher non-vertebral fracture-reducing potency in patients with a creatinine clearance (CrCl) below 60 ml/min (p = 0.0019). There were no serious adverse events (SAE), and the numbers of mild-to-moderate adverse events (AE) were not different between groups. Despite the higher initial fracture risk in the alfacalcidol group, 2-year treatment with this active D-hormone prodrug showed a higher therapeutic efficacy in terms of BMD, falls and fractures. One important advantage of alfacalcidol may be that it is effective even in patients with mild-to-moderate renal insufficiency.
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References
Ringe JD, Farahmand P, Faber H, Dorst A (2009) Sustained efficacy of risedronate in men with primary and secondary osteoporosis: results of a 2-year study. Rheumatol Int 29:311–315
Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6:29
Ringe JD (2000) Osteoporosis in men. In: Hosking D, Ringe J (eds) Treatment of metabolic bone disease. Management strategy and drug therapy. Martin Dunitz, London
Gennari L, Bilezikian JP (2007) Osteoporosis in men. Endocrinol Metab Clin N Am 36:399–419
Ringe JD (2007) Treatment of osteoporosis in men. JMHG (Elsevier) 4:326–333
National Osteoporosis Foundation (NOF) (2002) America’s bone health: the state of osteoporosis and low bone mass. National Osteoporosis Foundation, Washington, DC
EPOS Group (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724
Ringe JD, Schacht E (2009) Potential of alfacalcidol for reducing increased risk of falls and fractures. Rheumatol Int 29(10):1177–1185
Ringe JD (2006) Alfacalcidol in prevention and treatment of all major forms of osteoporosis and renal osteopathy. Georg Thieme, Verlag, Stuttgart, New York
Ringe JD, Dorst A, Faber H, Schacht E, Rahlfs VW (2004) Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoid-induced osteoporosis. Rheumatol Int 24:63–70
Ringe JD, Farahmand P, Schacht E, Rozehnal A (2007) Superiority of a combined treatment of alendronate and alfacalcidol compared to the combination of alendronate and plain vitamin D or alfacalcidol alone in established postmenopausal or male osteoporosis (AAC-trial). Rheumatol Int 27:425–434
Black DM, Cummings SR (1996) Karpf DBl. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541
Cummings SR, Black DM, Thompson DE (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the fracture intervention trial. JAMA 280:2077–2082
Harris ST, Watts NB, Genant HK (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352
Chesnut CK, Silverman S, Adriano K, Genant H, Gimona A, Harris S, Kiel D, Watts N, Baylink D (2000) A randomized trial of nasal spray calcitonin in post-menopausal women with established osteoporosis. Am J Med 109:267–276
Ettinger B, Black DM, Mitlak B (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645
Reginster J, Minne HW, Sorensen OH (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11:83–91
Holzer G et al (2009) Hip fractures and the contribution of cortical versus trabecular bone to femoral neck strength. J Bone Miner Res 24(3):468–474
Zebaze RMD, Ghasem-Zadeh A, Bhote A, Iuliano-Burns S, Mirams M, Price RI, Mackie E, Seeman E (2010) Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a cross sectional study. The Lancet 375:1729–1736
Shiraishi A, Higashi S, Ohkawa H, Kubodera N, Hirasawa T, Ezawa I, Ikeda K, Ogata E (1999) The advantage of alfacalcidol over vitamin D in the treatment of osteoporosis. Calcif Tissue Int 65:311–316
Shiraishi A, Takeda S, Masaki T, Higuchi Y, Uchiyama Y, Kubodera N, Sato K, Ikeda K, Nakamura T, Matsumoto T, Ogata E (2000) Alfacalcidol inhibits bone resorption and stimulates formation in an ovariectomized rat model of osteoporosis—distinct actions from estrogen. J Bone Miner Res 15:770–779
Iwamoto J et al (2006) Effect of risedronate on the cortical and cancellous bone mass and mechanical properties in ovariectomized rats: a comparison with the effects of alfacalcidol. J Nutr Sci Vitaminol 52:393–401
Felsenberg D, Bock O, Borst H, Armbrecht G, Beller G, Degner C, Stephan-Oelkers M, Schacht E, Mazor Z, Hashimoto J, Roth H-J, Martus P, Runge M (2011) Additive impact of alfacalcidol on bone mineral density and bone strength in alendronate treated postmenopausal women with reduced bone mass. J Musculoskelet Neuronal Interact 11(1):34–45
Orimo H, Nakamura T, Fukunaga M, Ohta H, Hosoi T, Uemura Y, Kuroda T, Miyakawa N, Ohashi Y, Shiraki M, For the A-TOP (Adequate Treatment for Osteoporosis) Research Group (2011) Effects of Alendronate plus Alfacalcidol in osteoporosis patients with a high risk of fracture: the Japanese Osteoporosis Intervention Trial (JOINT)-02. Curr Med Res Opin 27(6):1273–1284
Ringe JD, Schacht E (2007) Improving the outcome of established therapies for osteoporosis by adding the active D-hormone analog alfacalcidol. Rheumatol Int 28:103–111
Ringe JD, Schacht E (2004) Prevention and therapy of osteoporosis: the roles of plain vitamin D and alfacalcidol. Rheumatol Int 24:189–197
Schacht E (2007) Reduction of falls and osteoporotic fractures: plain vitamin D or D-hormone analogs? Geriatr Gerontol Int 7:S16–S25
Runge M, Schacht E (2005) Multifactorial pathogenesis of falls as a basis for multifactorial interventions. J Musculoskelet Neuronal Interact 5(2):127–134
Järvinen TLN, Sievanen H, Khan KM, Heinonem A, Kannis P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. Brit Med J 336:124–126
Birge SJ (2008) Osteoporotic fractures: a brain or bone disease? Curr Osteoporotic Rep 6:57–61
Cheung AM, Detsky AS (2008) Osteoporosis and fractures. Missing the bridge? JAMA 299(12):1468–1470
Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O (2010) Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuro Eng Rehabil 7:50. doi:10.1186/1743-0003-7-50
Dukas L, Bischoff HA, Lindpaintner LS, Schacht E, Birkner-Binder D, Damm TN, Thalmann B, Stahelin JB (2004) Alfacalcidol reduces the number of fallers in a community dwelling elderly population with a minimum calcium intake of more than 500 mg daily. J Am Geriatr Soc 52:230–236
Dukas L, Schacht E, Mazor Z, Stahelin HB (2005) Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance <65 ml/min. Osteoporos Int 16:198–203
Richy F, Dukas L, Schacht E (2008) Differential effects of D-hormone analogs and native vitamin D on the risk of falls: a comparative meta-analysis. Calcif Tisue Int 82:102–107
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Ringe, J.D., Farahmand, P. & Schacht, E. Alfacalcidol in men with osteoporosis: a prospective, observational, 2-year trial on 214 patients. Rheumatol Int 33, 637–643 (2013). https://doi.org/10.1007/s00296-012-2429-x
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DOI: https://doi.org/10.1007/s00296-012-2429-x