Z Gastroenterol 2005; 43 - 83
DOI: 10.1055/s-2005-869730

Active vitamin-D treatment in patients with Crohn's disease complicated

P Miheller 1, Gy Műzes 1, M Tóth 1, L Herszényi 1, T Zágoni 1, A Blázovits 1, Zs Tulassay 1
  • 1Semmelweis Egyetem, II. Belklinika

Introduction: Osteoporosis is a well known complication of Crohn's disease (CD). The most important factors in this field are the alterations of vitamin-D and calcium (Ca) homeostasis. Some recently developed biochemical markers are suitable to evaluate the efficacy of the therapy. Beta-CrossLaps (bCL) is indicative for bone resorption, while osteocalcin (OC) characterises bone formation. The tendency of bone turnover above all depends on the ratio of osteoprotegerin (OPG) and receptor activating NF-κ-B ligand (RANKL).

Aim: Our aim was to evaluate the difference of the antiporotic therapy using conventional (cVD) or (1,25) OH vitamin-D3 (aVD).

Patients and methods: 37 CD patients with low mineral density were treated according to the international guidelines. Group A (n=19) was treated with 50µg aVD, while 1000IU cVD was given to group B (n=18). All patients' therapy was supplemented with 1000mg of Ca, furthermore patients with osteoporosis were treated with 35mg/week risedronate. The OC and bCL were measured by immunoassay and the OPG and RANKL were determined by ELISA in the beginning and at week 6. Results are given in mean±SD and pg/ml.

Results: The OC concentrations of the group A on week 0 and 6 were 30.95±19.31 and 37.27±22.97 resp. (ns), and the bCL levels were 0.476±0.275 and 0.635±0.355 (ns), while the OPG concentrations were 4.42±3.11 and 5.33±3.32 (p<0.003) resp. The OC level at week 0 and 6 in the group B were 34.82±16.74 and 31.64±16.91 (p<0.001), and the bCL concentrations were 0.506±0.243 and 0.418±0.262 (p<0.02) resp. The OPG concentrations were 3.94±1.54 and 4.42±1.38 (p<0,01) in the group B at week 0 and 6 resp.

Conclusions: OPG levels rised in both groups. In general the protein decreases the activity of osteoclasts. The bone turnover seemed to decrease in group treated with cVD, while it seems to increase in group treated with aVD. The difference between these treatments can be further analyzed by measurements of the alterations of bone mineral density.