PARENTERAL CALCITONIN FOR METABOLIC BONE-DISEASE ASSOCIATED WITH PRIMARY BILIARY-CIRRHOSIS

No satisfactory treatment is available for metabolic bone disease asso ciated with primary biliary cirrhosis. On the basis of the similaritie s to postmenopausal osteoporosis, the rationale exists for calcitonin to be tested in clinical studies in patients with primary biliary cirr hosis-associated osteoporosis. We evaluated the effect of calcitonin o n bone metabolism and mineral density in 25 women with primary biliary cirrhosis and severe osteopenia. After 6 mo of observation, patients received a synthetic calcitonin or a control treatment consisting of l ess than one hundredth of the recommended dose of porcine calcitonin. The two treatments were administered in sequence to each patient for t wo 6-mo periods, with a 3-mo washout between them, according to a cros sover design. After the observation period, oral calcium supplementati on was started. Bone mineral density was measured by dual-photon absor ptiometry of the lumbar spine at study entry and at the beginning and the end of each treatment period. During the observation period bone m ineral density fell by 3.5% whereas during the following 6 mo it incre ased in both the patients who received calcitonin (4.3%) and those who received the control treatment (4.9%). Conversely, after the crossove r, bone mineral density decreased during both calcitonin (-2.7%) and c ontrol treatment (-2.9%). A significant difference was observed betwee n the two periods but not between the two treatments or between the tw o sequences of treatment administration. In conclusion, our findings i ndicate that parenterally administered calcitonin for 6 mo is ineffect ive in halting bone loss in patients with primary biliary cirrhosis-as sociated metabolic bone disease, whereas calcium supplementation may h ave a transient beneficial effect.