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Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min

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Abstract

We previously observed that a creatinine clearance (CrCl) of <65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 μg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of <65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08–0.80, P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09–0.88, P=0.028). No such association was observed in participants with a CrCl of ≥65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34–2.52, P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34–2.54, P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of <65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.

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Acknowledgements

We are indebted to the participants and all our study co-workers; to the team from the laboratory of Rheumatology at the Felix-Platter Spital, Basel, Switzerland as well as to the team of the Hospital Pharmacy of the Kantonsspital, Basel, Switzerland; to Professor John Orav (Division of Clinical Epidemiology, Brigham and Women’s Hospital, Boston, USA) for statistical consultation and advice; to Dr. A. Monsch for advice and encouragement in the preparation of the study protocol and study conduct. The study was supported by the following institutions: TEVA Pharmaceuticals Industries Ltd, Israel and a scientific grant from the University Hospital Basel, Switzerland.

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Authors and Affiliations

  1. Geriatric University Clinic, Kantonsspital, Basel, Switzerland

    Laurent Dukas & Hannes B. Stähelin

  2. Metabolic Bone Disease Unit, Universitätsklinik Balgrist, Zürich, Switzerland

    Erich Schacht

  3. Bone Metabolism Unit, TEVA Pharmaceutical Industries, Jerusalem, Israel

    Ze’ev Mazor

  4. Geriatric University Clinic, Ambulatorium Wiesendamm, Wiesendamm 22, 4057, Basel, Switzerland

    Laurent Dukas

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  1. Laurent Dukas
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  2. Erich Schacht
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  3. Ze’ev Mazor
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  4. Hannes B. Stähelin
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Correspondence to Laurent Dukas.

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Dukas, L., Schacht, E., Mazor, Z. et al. Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min. Osteoporos Int 16, 198–203 (2005). https://doi.org/10.1007/s00198-004-1671-9

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  • DOI: https://doi.org/10.1007/s00198-004-1671-9

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