Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Clin Interv Aging. 2014 Mar 28;9:515-26. doi: 10.2147/CIA.S40465. eCollection 2014.
Osteoporosis, a skeletal disorder characterized by a reduction in bone strength, is becoming a major public health problem in the People's Republic of China, with a rapid increase observed among the population. Chinese guidelines particularly recommend use of active vitamin D in managing osteoporosis. 1,25-(OH)2D3 (calcitriol) is an active vitamin D metabolite. It plays a role in many biological processes, especially in bone metabolism and muscle function, and is mediated by vitamin D receptors. Osteoporosis in elderly men and women is characterized by uncoupled bone remodeling, which is induced by sex hormone deficiencies, somatopause, vitamin D deficiency, reduced synthesis of D hormone, and lack of receptors or receptor affinity for D hormone in target organs. Reviewed here are six randomized controlled trials on calcitriol monotherapy and five on calcitriol therapy combined with other antiosteoporotic agents. Evidence from these trials shows that calcitriol monotherapy can improve bone mineral density in elderly osteoporotic Chinese patients but may be insufficient for long-term treatment. Calcitriol can also decrease bone turnover markers and bring about significant improvements in muscle strength. Further, calcitriol in combination with other therapeutic bone agents was shown to be well tolerated and capable of additional bone-preserving effects compared with use of calcitriol alone in areas including bone mineral density, bone turnover markers, bone pain improvement, and fracture incidence. Hypercalcemia and hypercalciuria, the most common side effects of calcitriol therapy, were not documented in the trials reviewed, and might have been the result of the low dosages used. One study showed that treatment with calcitriol can improve quality of life in patients with osteoporosis, although not to the same extent as bisphosphonates.
骨质疏松症是一种骨骼疾病，其特征是骨强度降低，在中国已成为一个主要的公共卫生问题，其发病率在人群中迅速增加。中国指南特别推荐使用活性维生素 D 来治疗骨质疏松症。1,25-(OH)2D3（骨化三醇）是一种活性维生素 D 代谢物。它在许多生物学过程中发挥作用，特别是在骨骼代谢和肌肉功能中，由维生素 D 受体介导。老年男女的骨质疏松症表现为骨重建解偶联，这是由性激素缺乏、somatopause、维生素 D 缺乏、D 激素合成减少以及靶器官中 D 激素受体或受体亲和力缺乏引起的。本文综述了关于骨化三醇单药治疗的 6 项随机对照试验和 5 项骨化三醇联合其他抗骨质疏松药物治疗的试验。这些试验的证据表明，骨化三醇单药治疗可以改善老年中国骨质疏松症患者的骨密度，但可能不足以长期治疗。骨化三醇还可以降低骨转换标志物，并显著改善肌肉力量。此外，与单独使用骨化三醇相比，骨化三醇与其他治疗性骨药物联合使用在包括骨密度、骨转换标志物、骨痛改善和骨折发生率在内的多个方面显示出更好的耐受性和额外的骨保护作用。在综述的试验中没有记录到骨化三醇治疗最常见的副作用——高钙血症和高钙尿症，这可能是由于使用的剂量较低。一项研究表明，骨化三醇治疗可以改善骨质疏松症患者的生活质量，但不如双膦酸盐那样显著。
