Intravenous calcitriol can increase bone mass in hemodialysis patients with osteitis fibrosa.

Intravenous calcitriol administration (IVC) suppressed parathyroid hormone (PTH) secretion and improved osteitis fibrosa (OF) in long-term hemodialysis (HD) patients, although it did not increase the mineralized bone area or the mineral apposition rate. We observed the long-term effects of IVC on OF in 8 HD patients. Bone biopsy of 7 patients revealed increased bone turnover and decreased bone mass. One microgram of calcitriol was given intravenously three times weekly after each HD session for 12 months. The dose was adjusted to maintain the serum corrected calcium level at < 11.5 mg/dl. Dual-energy X-ray bone absorptiometry (DEXA), 3rd lumbar vertebra bone density by quantitative computed tomography (QCT), and biochemical data were taken before IVC, and after 6 and 12 months of IVC. Seven HD patients were given 0.5 microgram/day 1 alpha-cholecalcitriol as controls. The serum corrected calcium levels were 9.9 +/- 0.3 (mean +/- SE) and 11.1 +/- 0.2 mg/dl at 0 and 12 months, respectively (p = 0.06). The serum phosphate levels were 6.2 +/- 0.7 and 6.6 +/- 0.6 mg/day at 0 and 12 months, respectively (p = 0.56). The serum intact PTH levels were 928 +/- 281 and 617 +/- 192 (p = 0.016) at 0 and 12 months, respectively. The bone mass of the 3rd lumbar vertebra measured by QCT was 195 +/- 17 and 218 +/- 186 g/cm3 at 0 and 12 months, respectively (p = 0.156). The bone mass of the trunk measured by DEXA was 660 +/- 44 and 706 +/- 32 g and 0 and 12 months, respectively (p = 0.156). These parameters did not change in controls. Sequential bone biopsy in 3 cases also supported these changes. We conclude that IVC not only suppresses bone turnover, but that it also restores decreased bone mass in HD patients with OF.