Results of conservative treatment in patients with phosphate diabetes

Stepan Martsyniak; Iurii Guk; Kinchaya-Polishchuk Tamara; Andrii Zyma; David G Stewart; Gennadii Bondariev; Olha Pankina

doi:10.1530/boneabs.4.P194

Objective: Bone metabolism was studied in patients with phosphate diabetes before and after medication.

Methods: 39 patients with phosphate diabetes age 2–18 years (7.8±4 years, 64% male) and multiplanar deformities of the lower extremities were treated with monthly vitamin D (2000 IU/day), alfacalcidol (0.25 mg/every other day) and calcium glycerophosphate (600 mg/day) for 6 months.

Biochemical indices were evaluated before (n=39) and after treatment (n=5), Table 1.

Results: After treatment, 25-hydroxy vitamin D increased 2.12 times (P<0.05), 1,25-dihydroxy vitamin D increased 1.8 times (P<0.05), and osteocalcin decreased in two times (P<0.05).

Strong correlations were observed only between 25-hydroxy vitamin D and 1,25-dihydroxy vitamin D (Table 2).

After treatment, positive correlations were seen between Ca and Ca+, Ca+ and 1,25-dihydroxy vitamin D, 25-hydroxy vitamin D and osteocalcin, 25-hydroxy vitamin D and B-CTx, 1,25 dihydroxy vitamin D and P1NP, urinary calcium and urinary phosphate, B-CTx and osteocalcin. Negative correlations were observed between PTH and 1,25-dihydroxy vitamin D, PTH and B-CTx, urinary phosphate and osteocalcin, B-CTx and urinary phosphate. (Table 3)

Table 1
Indicators of bone metabolism/stages of treatment	Before treatment	After treatment
Ionized calcium	1.21±0.01	1.25^†±0.02
Serum phosphate	0.62±0.03	0.67±0.07
Calcium	2.34±0.02	2.44^†±0.03
25(OH)₂D	19.30±2.01	40.97*±7.07
1,25(OH)₂D	74.15±3.89	134.60*±13.39
PTH	48.66±4.59	39.01±12.86
Osteocalcin	123.35±10.27	59.11*±34.05
Urinary calcium (daily)	2.42±0.25	2.54±0.94
Urinary phosphate (daily)	34.09±1.36	26.52^†±3.15
P1NP	815.03±59.86	576.4±205.65
B-CTx	2.16±0.11	1.69±0.46
*Significant difference treatment P<0.05. ^†Trend close to significant, 0.1> P>0.05.

Table 2
	Ca+	P	Ca	25(OH)2D	1,25(OH)2D	PTH	Osteocalcin	Urine calcium (daily)	Urine phosphor (daily)	P1NP	B-CTx
Ca+	1.00	0.16	0.24	0.04	0.03	0.06	0.06	0.27	−0.02	0.35	0.02
P	0.16	1.00	0.25	0.27	0.24	0.07	0.19	−0.04	−0.63	0.04	0.04
Ca	0.24	0.25	1.00	0.23	0.52	−0.38	−0.13	−0.18	−0.42	0.24	−0.09
25(OH)2D	0.04	0.27	0.23	1.00	0.80	−0.34	−0.01	−0.30	−0.13	0.06	0.23
1,25(OH)2D	0.03	0.24	0.52	0.80	1.00	−0.39	−0.38	−0.31	−0.34	−0.04	0.05
PTH	0.06	0.07	−0.38	−0.34	−0.39	1.00	−0.32	0.49	0.37	−0.36	−0.62
osteocalcin	0.06	0.19	−0.13	−0.01	−0.38	−0.32	1.00	−0.02	−0.19	0.52	0.60
urine calcium (daily)	0.27	−0.04	−0.18	−0.30	−0.31	0.49	−0.02	1.00	0.41	0.27	−0.01
urine phosphor (daily)	−0.02	−0.63	−0.42	−0.13	−0.34	0.37	−0.19	0.41	1.00	−0.13	−0.18
P1NP	0.35	0.04	0.24	0.06	−0.04	−0.36	0.52	0.27	−0.13	1.00	0.74
B-CTx	0.02	0.04	−0.09	0.23	0.05	−0.62	0.60	−0.01	−0.18	0.74	1.00
Correlations (marc vdrr.sta). Marked correlations are significant at P<0.05000. n=39 (Casewise deletion of missing data).

Table 3
	Ca+	P	Ca	25(OH)2D	1,25(OH)2D	PTH	Osteocalcin	Urine calcium (daily)	Urine phosphor (daily)	P1NP	B-CTx
Ca+	1.00	0.11	0.85	−0.35	0.86	−0.50	0.28	0.61	0.06	0.48	0.03
P	0.11	1.00	−0.37	−0.60	−0.12	0.69	0.28	0.70	0.59	0.18	−0.53
Ca	0.85	−0.37	1.00	−0.16	0.75	−0.70	−0.23	0.18	−0.25	0.24	0.16
25(OH)2D	−0.35	−0.60	−0.16	1.00	0.16	−0.57	0.90	−0.66	−0.68	0.40	0.92
1,25(OH)2D	0.86	−0.12	0.75	0.16	1.00	−0.79	0.18	0.38	−0.21	0.75	0.52
PTH	−0.50	0.69	−0.70	−0.57	−0.79	1.00	−0.41	0.20	0.56	−0.50	−0.78
Osteocalcin	−0.28	−0.28	−0.23	0.90	0.18	−0.41	1.00	−0.56	−0.75	0.64	0.89
Urine calcium (daily)	0.61	0.70	0.18	−0.66	0.38	0.20	−0.56	1.00	0.77	0.18	−0.46
Urine phosphor (daily)	0.06	0.59	−0.25	−0.68	−0.21	0.56	−0.75	0.77	1.00	−0.41	−0.75
P1NP	0.48	0.18	0.24	0.40	0.75	−0.50	0.64	0.18	−0.41	1.00	0.68
B-CTx	0.03	−0.53	0.16	0.92	0.52	−0.78	0.89	−0.46	−0.75	0.68	1.00
Correlations (marc vdrr.sta). Marked correlations are significant at P<0.05000. n=5 (Casewise deletion of missing data).

Conclusions: The medication protocol improves bone metabolism with phosphate diabetes, reduces osteomalacia, and improves ratios of bone formation and bone resorption.

Disclosure: The authors declared no competing interests.

Bone Abstracts

P194