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Clinical Cases in mineral and bone metabolism

The role of alfacalcidol

Mini-review, 173 - 176
doi: 10.11138/ccmbm/2018.15.2.173
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Abstract
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Alfacalcidol (1 alpha-hydroxy vitamin D3) is a synthetic vitamin D analogue which does not need to pass through kidneys for hydroxylation. It is hydroxylated fully in the liver and bone at position 25 to 1,25 (OH)2D3.
Preclinical studies have suggested the superiority of alfacalcidol on both bone metabolism and osteoporosis treatment compared to plain vitamin D. Alfacalcidol has been shown to increase BMD by ameliorating intestinal calcium absorption and/or directly affecting bone cells and this effect is particularly evident when given in combination with anticatabolic drugs. Alfacalcidol seems to have additional preventive effects against the risk of falling, probably due to a direct action on the specific muscle receptor. In fact, in elderly sarcopenic patients alfacalcidol may improve the balance so reducing the risk of falls and, consequently, also the risk of fracture.
Moreover, 1-alpha-calcidol is indicated in conditions of deficiency of the enzyme 1 alpha hydroxylase (eg, moderate-to-severe renal insufficiency, hypoparathyroidism and mutations in the gene encoding the enzyme 1-alphahydroxylase) and of intestinal malabsorption. However, at present, the efficacy of alfacalcidol in reducing osteoporotic fractures has not yet been defined. More data from randomized controlled trials are warranted in order to better define the role of alfacalcidol in the therapeutical strategies for osteoporosis.

Vol. XV (No. 3) 2018 September - December

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    doi: 10.11138/ccmbm/2018.15.2.173
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