Effectiveness of bisphosphonate combined with activated vitamin D in patients with aromatase inhibitor-induced osteoporosis after breast cancer operation

OBJECTIVES: We compared the effectiveness of bisphosphonates combined with activated vitamin D administered for therapy of aromatase inhibitor-induced osteoporosis after a breast cancer operation and primary postmenopausal osteoporosis through propensity score matching. METHODS: Forty-eight postmenopausal patients with estrogen receptor-positive early breast cancer, who had postoperative adjuvant treatment with aromatase inhibitors and whose T-score of bone mineral density (BMD) decreased below −2.5 (AI group), and 48 patients of primary postmenopausal osteoporosis (PO group) enrolled in this retrospective observational study. They were administered monthly risedronate or minodronate, and daily alfacalcitol or eldecalcitol were combined. Their BMD (L2–4, L-BMD), serum-corrected calcium, serum phosphate, tartrate-resistant acid phosphatase 5b (TRACP-5b), bone alkaline phosphatase (BAP), estimated glomerular filtration rate, urine calcium/creatinine ratio, intact-parathyroid hormone, and 25-hydroxy vitamin D were measured before treatment and until 24 months. RESULTS: L-BMD values increased with time compared with the baseline values in each group, and there was no significant difference in the groups. Percentage value of TRACP-5b decreased rapidly after 6 months and maintained low level until 24 months in both groups. Percentage value of BAP in the AI group decreased continuously until 24 months. In contrast, the percentage change in the PO group plateaued after 6 months. CONCLUSIONS: It is suggested that monthly oral bisphosphonate combined with activated Vitamin D is an effective therapy to increase BMD in the aromatase inhibitor-induced osteoporosis after breast cancer operation. Monitoring of kidney function and concentration of Ca in blood and urine may be necessary.

Research progress on the prevention and treatment of diabetic nephropathy by activated vitamin D3 immu-noregulation / 医学研究生学报

Diabetic nephropathy is caused by manifold factors .Increasing evidences suggest that immunoregulation abnormality caused by inflammatory cell infiltration and proinflammatory factor overexpression in kidney tissue has a key role in the occurrence and development of diabetic nephropathy .As a novel immunomodulator , activated vitamin D 3 could inhibit inflammatory factor and regulate immunity response .The author reviews the effect of activated vitamin D 3 related to diabetic nephropathy , from the pointviews of immu-nocyte, cytokines and rennin-angiotensin system.The roles of macrophage, T lymphocytes, dendritic cell, transforming growth factor-β1, and rennin-angiotensin system in kidney injury and immunal regulation of activated vitamin D 3 are discussed.

Effect of Calcium and Activated Vitamin D ( 1- hydroxyvitamin-D ) on Bone Mineral Density in Osteoporosis / 대한정형외과학회잡지

Forty-five elderly female osteoporotics were given daily dose of 750 mg of calcium and 1.0 microgram of activated vitamin D (1-a hydroxyvitamin D) orally for 24 months to evaluated the effect of drugs on bone mineral density. Bone mineral density was evaluated and repeated every 6 months for 2 years. Average bone mineral density (L (2)-L (4)) and T score were 0.773 (SD 0.120) and -2.90 (SD 0.97) before treatment, and increased to 0.808 (SD 0.121) and -2.59 (SD 0.97) after 24 months of therapy, respectively (p<0.01). During treatment, complications including hypercalcemia, hypercalciuria, or renal stone were not observed, and indicators of renal function were normal. Therefore the activated vitamin D treatment in osteoporosis is effective in diminishing normal decline of bone mineral density, especially in areas with low calcium and vitamin D intake, such as South Korea.