Rationale for Treatment of Involutional Osteoporos

Authors: E Schacht

Publish Date: 2014/03/06

Volume: 65, Issue: 4, Pages: 317-327

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Abstract

Increased cytokine release and increased activity of osteoclasts reduced osteoclast apoptosis due to a fall in estrogen is of causal significance in postmenopausal bone loss as well as malfunction of the vitamin D activation and concomitant calcium Ca malabsorption Alfacalcidol prevents rapid postmenopausal bone loss by elimination of Ca malabsorption and by blocking resorbing cytokinesEstablished osteoporosis in older patients of both sexes is characterized by decoupled bone remodeling induced by sex hormone deficits and by a socalled somatopause insulinlike growth factor IGFdeficit but also by lack of vitamin D and very importantly by reduced synthesis of Dhormone Calcitriol in kidneys and bone as well as by a lack of receptors or receptor affinity for Dhormone in the target organs As a consequence of these facts a rise in parathormone PTH frequently occurs The lack of Dhormone and IGF1 evidently causes a reduction in muscle strength as well and reinforces the risk of falling and thus the risk of a fractureAlfacalcidol a prodrug of Dhormone is a specific antiosteoporotic therapy In alfacalcidol therapy Dhormone is provided to the body in circumvention of its own regulation by means of which much higher hormone concentrations can be achieved in the target tissues than by administration of plain vitamin DChances have been significantly improved of reducing and frequently preventing the real osteoporosis complication for older male and female patients ie bone fractures by alfacalcidol A clear distinction should be made between supplementation with lowdosed plain vitamin D and calcium as base supply in elderly housebound subjects or as adjuvant to antiosteoporotic drugs and the specific antiosteoporotic therapy with alfacalcidol in patients with osteoporosisThe expanded understanding of the pathogenesis of corticosteroidinduced osteoporosis with its disturbed Ca homeostasis and the pharmacological effects of alfacalcidol counteracting such iatrogenic bone loss explain the particularly good clinical efficacy in this most frequent form of secondary osteoporosisNormalizing decoupled bone remodeling due to cytokine modulation and the potential influence on deteriorated bone quality in patients with rheumatoid arthritis and Crohns disease predestine this form of therapy for prevention and treatment of osteoporosis as a result of chronic inflammatory diseases as well as of transplantation osteoporosis cases in particular

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