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Short-term calcitriol administration improves calcium homeostasis in adults with cystic fibrosis

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Abstract

Osteoporosis is a well-defined health risk in cystic fibrosis (CF) patients due to many factors. Vitamin D insufficiency, despite routine cholecalciferol supplementation in CF patients, may contribute to a relative secondary hyperparathyroidism and possibly deficient bone mineralization. An alternate form of vitamin D, calcitriol, was studied to determine short-term effects on fractional calcium absorption and other calciotropic markers in 10 adult CF subjects and in 10 age-, sex- and body mass index (BMI)-matched controls. Serum fractional absorption of 45Ca was determined after a calcium-containing meal prior to calcitriol intervention. Other measurements included serum parathyroid hormone (PTH), ionized calcium, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D) and urinary calcium:creatinine and N-telopeptide (NTx) concentrations. Both groups were then given calcitriol (0.5 µg p.o. b.i.d. for 14 days) and restudied following the same protocol. Both groups increased their fractional absorption of 45Ca after calcitriol (p=0.015 CF subjects, p=0.001 controls), although calcitriol tended to be less effective in the CF group compared with the controls (p=0.055). Post-prandial serum PTH concentrations were suppressed compared with baseline in both groups (p=0.03 CF subjects, p=0.006 controls). Urinary NTx concentrations, a marker for bone resorption, decreased significantly in CF subjects after calcitriol (96.0±16.0 vs 63.9±12.7 nmol BCE/mmol Cr, p=0.01) and remained unchanged in the control group. The controls had an increase in serum 1,25(OH)2D concentrations (69.9±4.2 vs 90.7±9.6 pmol/l, p=0.02) while there was no significant change in the CF group. Oral calcitriol administration appears to improve markers of calcium balance in adults with CF by increasing fractional absorption of 45Ca and lowering PTH concentrations, similar to its known effects in healthy subjects, while also suppressing urinary NTx, a marker of bone turnover.

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Acknowledgements

This research was funded in parts by the Cystic Fibrosis Foundation (Aris00A0); the Verne S. Caviness General Center for Clinical Research (NIH RR00046); NIH, National Research Service Award (DK07129), NIDDK; 5T35 DK 07386, NIDDK; UNC Clinical Nutrition Research Unit, NIH (DK56350); the Food and Drug Administration (FDR-001518-01); NIH, Agency for Health Care Policy and Research (U18 HS10397-01). The authors wish to thank the nursing and dietary staff in the GCRC and Rebekkah Dann and Burton Levine, MS for assistance with statistical analysis.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, The University of North Carolina at Chapel Hill, North Carolina, USA

    S. A. Brown & D. A. Ontjes

  2. Division of Endocrinology, UNC, CB#7172, Bioinformatics Building #1163A, 130 Mason Farm Road, Chapel Hill, NC 27599-7172, USA

    S. A. Brown

  3. Division of Pulmonary Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, North Carolina, USA

    M. B. Hensler, M. J. Caminiti, D. C. Backlund & R. M. Aris

  4. Departments of Orthopedics, The University of North Carolina at Chapel Hill, North Carolina, USA

    G. E. Lester, R. K. Lark & A. D. Blackwood

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Brown, S.A., Ontjes, D.A., Lester, G.E. et al. Short-term calcitriol administration improves calcium homeostasis in adults with cystic fibrosis. Osteoporos Int 14, 442–449 (2003). https://doi.org/10.1007/s00198-002-1331-x

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  • DOI: https://doi.org/10.1007/s00198-002-1331-x

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