Oral calcitriol safely reduces fracture risk in patients receiving hemodialysis (HD) without increasing the burden of calcifications, a new study finds.

In the Vitamin K Italian (VIKI) study, 177 of 387 (45.7%) patients on HD were treated with oral calcitriol at doses of 0.25 to 1 μg/d for secondary hyperparathyroidism (SHPT). In an adjusted multivariable logistic regression analysis, oral calcitriol treatment was significantly associated with 40.2% decreased odds of vertebral fracture, compared with no treatment, and independent of serum calcium and phosphate levels, Maria Fusaro, MD, PhD, of National Research Council–Institute of Clinical Physiology in Pisa, Italy, and colleagues reported in the Journal of Bone and Mineral Research. Vertebral fracture was defined as a reduction in height of more than 20% on spine radiograph. The prevalence of vertebral fracture was significantly lower among treated than untreated patients: 48.6% vs 61.0%, respectively. The presence of aortic and iliac calcifications, however, was comparable (aortic: 81.9% vs 79.5%, respectively; iliac: 52.0% vs 59.5%, respectively).

Only patients treated with oral calcitriol were selected for the study, whereas those treated with intravenous calcitriol were excluded.

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“The involvement of active vitamin D in preventing bone fractures may be mediated by the decrease of the high risk of falls related to impaired muscle strength,” according to Dr Fusaro’s team.

In patients on HD, vitamin K1 deficiency is the strongest predictor of vertebral fracture, the investigators noted. In the adjusted analysis, a deficit in vitamin K1 and iliac calcifications were associated with significant 2.9- and 1.7-fold increased odds for fracture.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Fusaro M, Cianciolo G, Tripepi G, et al. Oral calcitriol use, vertebral fractures, and vitamin K in hemodialysis patients: a cross-sectional study. J Bone Miner Res. 2021 Dec;36(12):2361-2370. doi:10.1002/jbmr.4440