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Systematic review of the benefits and harms of calcitriol and alfacalcidol for fractures and falls

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Abstract

Our objective was to conduct a systematic review on the benefits and harms of calcitriol and alfacalcidol in the reduction of fracture and fall risk. Randomized controlled trials (RCTs) comparing these agents to placebo or calcium and reporting fracture and fall incidence were retrieved from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Two reviewers independently determined study eligibility, assessed trial quality, and extracted data. Twenty-three RCTs were included (2139 participants), and 16 trials had sufficient data for meta-analysis. Vertebral fractures were not significantly reduced based on the combined results of 13 trials; however, subgroup analyses demonstrated a significant reduction with alfacalcidol [odds ratio (OR) = 0.50, 95% confidence interval (CI), 0.25–0.98], but not with calcitriol. There was a significant reduction in nonvertebral fractures (six trials, OR = 0.51, 95% CI, 0.30–0.88), and falls (two trials, OR = 0.66, 95% CI, 0.44–0.98). There was an increased risk of hypercalcemia (OR = 3.63, 95% CI, 1.51–8.73) and a trend toward an increased risk of hypercalciuria. There is evidence to suggest that these agents may reduce the incidence of nonvertebral fractures and falls; however, their benefit on vertebral fracture reduction may depend on the type of active vitamin D. Hypercalcemia and hypercalciuria are potential side effects.

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Authors and Affiliations

  1. Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, ASB 1-006, Ottawa, Ontario, Canada, K1Y 4E9

    Siobhan O’Donnell

  2. Faculty of Medicine, Department of Epidemiology & Community Medicine, University of Ottawa and Chalmers Research Group, the Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

    David Moher

  3. Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

    Kelli Thomas

  4. Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    David A. Hanley

  5. Division of Rheumatology, Department of Medicine, The Ottawa Hospital and Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

    Ann Cranney

Authors
  1. Siobhan O’Donnell
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  2. David Moher
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  3. Kelli Thomas
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  4. David A. Hanley
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  5. Ann Cranney
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Correspondence to Siobhan O’Donnell.

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O’Donnell, S., Moher, D., Thomas, K. et al. Systematic review of the benefits and harms of calcitriol and alfacalcidol for fractures and falls. J Bone Miner Metab 26, 531–542 (2008). https://doi.org/10.1007/s00774-008-0868-y

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  • DOI: https://doi.org/10.1007/s00774-008-0868-y

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