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The effect of calcitriol on biochemical bone metabolism parameters in vitamin D deficient geriatric patients
593 GLANONASS NEOUCTION BY ETHANOL INJECTION IS PAHATHYHOIO IN AN EFFECTI:VE ADJUNCTTO CALCITRIOLPULSE THERAPY SEVEREHYPRRPARATHYROIDISM OF CHRONIC DIALYSISPATIENTS. n. Kitaoka. W. Fukauawa. K. Kutokawa. ‘6. Ouata. Division of Endocrinoloav b Metabolism, Showa General Hosnital. Department of -internal Medicine, University of -Tokyb School of Medicine, Tokyo, Japan.
592 SERUM PROCOLLAGEN: A NON.INVASIVE INDEX OF BONE FORMATION IN PATIENTS ON HAEMODIALYSIS? N.A.T. University of Leiden, The Netherlands. University of Oulu, Finland and University OfSheffield, UK. Bone formation has traditionally been assessed in the clinic by biochemical indices of osteoblastii: activity such as serum alkaline ahasnhalase (ALP) and ostaocakin (BGP). There are limilatkns, however, k iig interpreiatioh of biochemical itidies of bone formation, particularly in the oresence of renal failure. For this reason, we have compared the value of me serum carbxyterminal pmpeptide 01 human procollagen type I PCP), ALPand BGP as indirect indices of bone formation in 18 patients established on haemodialysis. Va!ues were compared to bone formation rates as assessed by bone histology.The value of PICP was also compared to that of ALP and BGP in the presence or absence of aluminium-related bone disease. Mean values for ALP, BGP, PTH and PICP were above the upper limitof normal, There was a significant correlation between PICP and ALP, and between PICP and BGP (r~0.55, ~~0.05; r-0.53. ~~0.05 respectively). PICP also correlated signlfkantly with histomorphomelrk indices of bone formallen, particularly bone formallon rates as estimated by the double cyclln&lrbelling technique (r~O.74, psO.Ol), but nrt with those of bone rrsorp~lon. The slope of Ihe relationshlp between BFR and PICP, ALP and BGP W&Ssimilar. Seven petlents had h191oChemiCaI and hlslolo~ical evidence of alumlniumrela~ed bona disease. In lhrse patlenls, serum aclivlty of ALP was less IOr any given value 01 PICP, and SerUm PICP was greater for any given bone formatlon rule than In paMnl$ without aluminlum toxicity. These findings suggest thal procollagon may be a useful non-invasive Index 01 bone formalion in pallenls on haemodlalysis, and thal alumlnium may have B dilferentlal effect an varkus aspects of osteoblaslic functlon in these patlenls.
Calcitriol pulse therapy is an effective means to suppress parathyroid hormone (PTW) secretion and the size of parathyroid glands in secondary hyperparathyroidism of However, in patients with chronic dialysis Patients. severe
hyperparathyroidism,
calcitriol sufficient
that causes hy:ercalcemia may not be to suppress PTH hypersecretion. In the study, the effect of ethanol injection on the
even
large
doses
of
present control of secondary hyperparathyroidism with calcitriol was examined in chronic dialysis patients who had been
resistant to calcitriol pulse therapy. Twelve parethyroid glands of B dialysis patients with severe secondary hyperparathyroidism were given ethanol injection (95 0 ethanol with 0.1 % lidocaine) under ultrasonographic guidance in a volume equivalent to 90 % The ultrasound examinations of each parathyroid gland. and ethanol injections were performed with a 10 MHs mechanical sector scanner (Aloka, Tokyo). After ethanol injection, the eixe of parathyroid glands decreased and internal echoes became hetaroganous, suggesting fibrotic changes of parathyroid glands by ethanol injection. Serum intact PTH levels also decreased after ethanol injection in all cases. Although serum intact PTHlevels rose q&n in two patients 2 to 6 months after ethanol
injection, they could be effectively suppressed by calcitriol pulse therapy. These results demonstrate that ethanol injection to parathyroid glands is a safe and effective treatment of choice to achieve mass reduction in severe hyperparathyroidism under chronic hemodialysis, and that the reduction in paratbyroid mass restores the responsiveness to calcitriol pulse therapy within doses that do not cause hyperLaI:emia. 595 594 A SINGLEWY IWXVWEWUSINFUSIC+lOF AMINOBISPHOSPHONATE THE EFFEC’: OF CALCITRIelL 0N BlOCHElblICAL BONE (PAMIlXCNATE) FORWE TREATMEW OF PAGm’S DISF!.ASE. METABOLISM PARAMETERS IN VITAMIN D DEFICIENT GERIATRIC PATIENTS
byal North Shore end Concord Hospitals, Sydney, NSW2139 Australia. We have treated 92 patients with Paget’s Disease with intravenous
Bamidsonate as pxt
of a dose finding
study
to
establish the efficacy oE a-single day infusion.- In this study, we have the response between 20, 30, 45 or 6hg of PmidronatG. Pssessmnis were made at 2, 4, 8, 12 and 24 weeks after infusion by the change in serum al&line phosphatase and fasting urinary hydroxyproline creatinine ratio. Patients with persistent activity of their disease ware reirlfused at 24 weeks. The single day infusion of APD was followed by a rapid and sustained biochmical respzmse but in only 16% of patients did the senm alkaline phosphatase fall to within the no-1 range. 93% of patients in wWn the semn alkaline phosphhatase nomlized had an initial serm alkaline ptXqhateso less than 3 times the upper limit of nomal. Whilst thare was no significant difference in the response between the lchuer dcsaqe czrouua in our studv. there was a greatr response in patients ‘treated with a-higher dose of Pmidmnate . Whilst the Ixxcentaqe fall in senm ,alkaline phosphatase fmn the initial baseiine was similar afttx the first and second infusion. the percentage fall or urinary hydroxyprolinelcrecltinine ratio was areater after the SWmrd infiiiim. These findings doronstrats that a single day infusion of Pamidronate is effective in the treabnent of Pagec’s Disease but in the doses given does not normalize bone turnover in severe disease.
P. Bernecker, P. Pletsclunann, W. Woloszcauk, H.Fletschmann Dept. of Internal Medicine III, Div. of Rheumatology, University of Vienna; Dept of Internal Medicine III, Geriatric Hospital Laint, Vienna; and Ludwig Boltzmann Institute of Clinical Endocrinology, Vienna, Austria. Vi’.amin D deficiency
hyperparathyroidism
geriatric patients.
influence of a vitamin D supplementation osteocalcin
(a specific
phosphatase
with calcitriol
geriatric
patients
levels of parathyroid the calcitriol osteocalcin of therapy, baseline
therapy. thereafter
values.
secondary
In contrast,
levels returned
the serum levels
and calcium showed no statistically throughout
the study.
of 0.25 pg calcitriol
hyperparsthyroidism
geriatric patients.
under
the serum
with a nadir at the seventh
the osteocalcin
female
The serum
significantly
After an initial increase
levels decreased
phosphatase variations
hormone decreased
alkaline
D deficient
over a period of nine months.
the
(daily
hormone,
parameter of bone formation),
and calcium in 26 vitamin
are
We determined
dose: 0.25 pg) on the serum levels of parathyroid
administration
224
and secondary
common in hospitalized
week to the
of alkaline significant
We conclude
that a daily
is effective in vitamill
in reducing I3 defidie!. 4
592 SERUM PROCOLLAGEN: A NON.INVASIVE INDEX OF BONE FORMATION IN PATIENTS ON HAEMODIALYSIS? N.A.T. University of Leiden, The Netherlands. University of Oulu, Finland and University OfSheffield, UK. Bone formation has traditionally been assessed in the clinic by biochemical indices of osteoblastii: activity such as serum alkaline ahasnhalase (ALP) and ostaocakin (BGP). There are limilatkns, however, k iig interpreiatioh of biochemical itidies of bone formation, particularly in the oresence of renal failure. For this reason, we have compared the value of me serum carbxyterminal pmpeptide 01 human procollagen type I PCP), ALPand BGP as indirect indices of bone formation in 18 patients established on haemodialysis. Va!ues were compared to bone formation rates as assessed by bone histology.The value of PICP was also compared to that of ALP and BGP in the presence or absence of aluminium-related bone disease. Mean values for ALP, BGP, PTH and PICP were above the upper limitof normal, There was a significant correlation between PICP and ALP, and between PICP and BGP (r~0.55, ~~0.05; r-0.53. ~~0.05 respectively). PICP also correlated signlfkantly with histomorphomelrk indices of bone formallen, particularly bone formallon rates as estimated by the double cyclln&lrbelling technique (r~O.74, psO.Ol), but nrt with those of bone rrsorp~lon. The slope of Ihe relationshlp between BFR and PICP, ALP and BGP W&Ssimilar. Seven petlents had h191oChemiCaI and hlslolo~ical evidence of alumlniumrela~ed bona disease. In lhrse patlenls, serum aclivlty of ALP was less IOr any given value 01 PICP, and SerUm PICP was greater for any given bone formatlon rule than In paMnl$ without aluminlum toxicity. These findings suggest thal procollagon may be a useful non-invasive Index 01 bone formalion in pallenls on haemodlalysis, and thal alumlnium may have B dilferentlal effect an varkus aspects of osteoblaslic functlon in these patlenls.
Calcitriol pulse therapy is an effective means to suppress parathyroid hormone (PTW) secretion and the size of parathyroid glands in secondary hyperparathyroidism of However, in patients with chronic dialysis Patients. severe
hyperparathyroidism,
calcitriol sufficient
that causes hy:ercalcemia may not be to suppress PTH hypersecretion. In the study, the effect of ethanol injection on the
even
large
doses
of
present control of secondary hyperparathyroidism with calcitriol was examined in chronic dialysis patients who had been
resistant to calcitriol pulse therapy. Twelve parethyroid glands of B dialysis patients with severe secondary hyperparathyroidism were given ethanol injection (95 0 ethanol with 0.1 % lidocaine) under ultrasonographic guidance in a volume equivalent to 90 % The ultrasound examinations of each parathyroid gland. and ethanol injections were performed with a 10 MHs mechanical sector scanner (Aloka, Tokyo). After ethanol injection, the eixe of parathyroid glands decreased and internal echoes became hetaroganous, suggesting fibrotic changes of parathyroid glands by ethanol injection. Serum intact PTH levels also decreased after ethanol injection in all cases. Although serum intact PTHlevels rose q&n in two patients 2 to 6 months after ethanol
injection, they could be effectively suppressed by calcitriol pulse therapy. These results demonstrate that ethanol injection to parathyroid glands is a safe and effective treatment of choice to achieve mass reduction in severe hyperparathyroidism under chronic hemodialysis, and that the reduction in paratbyroid mass restores the responsiveness to calcitriol pulse therapy within doses that do not cause hyperLaI:emia. 595 594 A SINGLEWY IWXVWEWUSINFUSIC+lOF AMINOBISPHOSPHONATE THE EFFEC’: OF CALCITRIelL 0N BlOCHElblICAL BONE (PAMIlXCNATE) FORWE TREATMEW OF PAGm’S DISF!.ASE. METABOLISM PARAMETERS IN VITAMIN D DEFICIENT GERIATRIC PATIENTS
byal North Shore end Concord Hospitals, Sydney, NSW2139 Australia. We have treated 92 patients with Paget’s Disease with intravenous
Bamidsonate as pxt
of a dose finding
study
to
establish the efficacy oE a-single day infusion.- In this study, we have the response between 20, 30, 45 or 6hg of PmidronatG. Pssessmnis were made at 2, 4, 8, 12 and 24 weeks after infusion by the change in serum al&line phosphatase and fasting urinary hydroxyproline creatinine ratio. Patients with persistent activity of their disease ware reirlfused at 24 weeks. The single day infusion of APD was followed by a rapid and sustained biochmical respzmse but in only 16% of patients did the senm alkaline phosphatase fall to within the no-1 range. 93% of patients in wWn the semn alkaline phosphhatase nomlized had an initial serm alkaline ptXqhateso less than 3 times the upper limit of nomal. Whilst thare was no significant difference in the response between the lchuer dcsaqe czrouua in our studv. there was a greatr response in patients ‘treated with a-higher dose of Pmidmnate . Whilst the Ixxcentaqe fall in senm ,alkaline phosphatase fmn the initial baseiine was similar afttx the first and second infusion. the percentage fall or urinary hydroxyprolinelcrecltinine ratio was areater after the SWmrd infiiiim. These findings doronstrats that a single day infusion of Pamidronate is effective in the treabnent of Pagec’s Disease but in the doses given does not normalize bone turnover in severe disease.
P. Bernecker, P. Pletsclunann, W. Woloszcauk, H.Fletschmann Dept. of Internal Medicine III, Div. of Rheumatology, University of Vienna; Dept of Internal Medicine III, Geriatric Hospital Laint, Vienna; and Ludwig Boltzmann Institute of Clinical Endocrinology, Vienna, Austria. Vi’.amin D deficiency
hyperparathyroidism
geriatric patients.
influence of a vitamin D supplementation osteocalcin
(a specific
phosphatase
with calcitriol
geriatric
patients
levels of parathyroid the calcitriol osteocalcin of therapy, baseline
therapy. thereafter
values.
secondary
In contrast,
levels returned
the serum levels
and calcium showed no statistically throughout
the study.
of 0.25 pg calcitriol
hyperparsthyroidism
geriatric patients.
under
the serum
with a nadir at the seventh
the osteocalcin
female
The serum
significantly
After an initial increase
levels decreased
phosphatase variations
hormone decreased
alkaline
D deficient
over a period of nine months.
the
(daily
hormone,
parameter of bone formation),
and calcium in 26 vitamin
are
We determined
dose: 0.25 pg) on the serum levels of parathyroid
administration
224
and secondary
common in hospitalized
week to the
of alkaline significant
We conclude
that a daily
is effective in vitamill
in reducing I3 defidie!. 4