The effects of Maxacalcitol therapy for the patients with secondary hyperparathyroidism on clinical symptoms, bone mineral density and parathyroid swelling

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  • Yasunaga Chikao
    Kidney Center, Saiseikai Yahata Hospital Kitakyushu Vitamin D and Metabolic Bone Diseases Study Group
  • Matsuo Kenzo
    Yahata Clinic Kitakyushu Vitamin D and Metabolic Bone Diseases Study Group
  • Tanaka Hiroshi
    Iseigaoka Clinic Kitakyushu Vitamin D and Metabolic Bone Diseases Study Group
  • Baba Mitsuo
    Department of Internal Medicine, Saiseikai Yahata Hospital Kitakyushu Vitamin D and Metabolic Bone Diseases Study Group
  • Nakamoto Masahiko
    Tagawa Municipal Hospital Kitakyushu Vitamin D and Metabolic Bone Diseases Study Group

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Other Title
  • 二次性副甲状腺機能亢進症に対するＭａｘａｃａｌｃｉｔｏｌ（オキサロール）による静注パルス療法は臨床症状，骨塩量の改善と副甲状腺の縮小に効果があるか
  • 2ジセイ フクコウジョウセン キノウ コウシンショウ ニ タイスル Maxacalcitol オキサロール ニ ヨル ジョウチュウ パルス リョウホウ ワ リンショウ ショウジョウ コツ エンリョウ ノ カイゼン ト フクコウジョウセン ノ シュクショウ ニ コウカ ガ アルカ

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Abstract

Vitamin D pulse therapy effectively reduced PTH production and corrected high turnover bone condition due to secondary hyperparathyroidism (2°HPT). However, it was not clear whether this therapy could improve clinical symptoms of the patients and bone mineral density, or reduce the size of enlarged parathyroid glands. We thus prospectively evaluated the effects of maxacalcitol, a lower calcemic vitamin D analogue, on these issue using dual energy x-ray absorptiometry (DEXA) and echosonography up to 1 year after initiating treatment. The patients consisted of 10 males and 12 females, aged from 37 to 79 years, who had undergone hemodialysis for 13.5±7.3 years. The patients received maxacalcitol intravenously at every hemodialysis session. The dose was adjusted to 2.5 to 15 μg/session according to PTH and serum calcium levels. The mean intact-PTH level was 865±392 pg/mL before treatment, which was reduced to 406±253 pg/mL after 1 year of treatment (p<0.01). Alp level was also reduced from 593±817 IU/L to 252±135 IU/L (p<0.01). Age-matched bone mineral density in L2-4 was increased from 87.8±14.2% to 91.0±16.0% (p=0.033). Clinical symptoms, such as osteoarticular pain, were also reduced. In contrast, total parathyroid volume, measured by echosonography, was increased from 0.40±0.68 cm3 to 0.49±0.76 cm3 (p=0.023). These results indicate that maxacalcitol therapy can improve bone mineral density but cannot reduce the swelling of the parathyroid glands in any case. In the subgroup patients with an intact-PTH increase of less than 200 pg/mL, total parathyroid volume showed a tendency of decrease. For patients resistant to maxacalcitol therapy, such radical treatment as parathyroidectomy or percutaneous ethanol injection therapy is recommended.

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