From the Guidelines
Alfacalcidol is used to treat conditions related to vitamin D deficiency and calcium metabolism disorders, specifically for patients with X-linked hypophosphataemia (XLH), hypocalcemia, osteoporosis, rickets, osteomalacia, hypoparathyroidism, and renal osteodystrophy in patients with chronic kidney disease. The primary use of alfacalcidol is to regulate calcium levels in the body by increasing calcium absorption from the intestines and reducing calcium excretion through the kidneys 1.
Key Indications
- X-linked hypophosphataemia (XLH)
- Hypocalcemia (low blood calcium)
- Osteoporosis
- Rickets
- Osteomalacia
- Hypoparathyroidism
- Renal osteodystrophy in patients with chronic kidney disease According to the clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia, alfacalcidol is recommended for treating children with overt XLH phenotype in combination with oral phosphorus (phosphate salts) as soon as diagnosis is established 1.
Dosage
The typical adult dosage of alfacalcidol ranges from 0.75 to 1.5 μg daily, though this may be adjusted based on blood calcium levels and individual response 1. It is essential to monitor calcium and phosphate levels regularly in patients taking alfacalcidol, as excessive doses can lead to hypercalcemia 1. Alfacalcidol works by being converted in the liver to the active form of vitamin D (calcitriol), bypassing the need for kidney activation, which makes it particularly useful for patients with kidney dysfunction who cannot properly activate regular vitamin D supplements 1. In adults, treatment with alfacalcidol is recommended in symptomatic patients with XLH to reduce osteomalacia and its consequences and to improve oral health 1. However, routine treatment of asymptomatic adults with XLH is not recommended 1. Substantially lower doses of active vitamin D and oral phosphate are used in adults compared to children, with a recommended dose range of 750–1,600mg daily for phosphate and 0.50–0.75 and 0.75–1.5μg daily for calcitriol and alfacalcidol, respectively 1.
From the FDA Drug Label
The kidneys of uremic patients cannot adequately synthesize calcitriol, the active hormone formed from precursor vitamin D. Resultant hypocalcemia and secondary hyperparathyroidism are a major cause of the metabolic bone disease of renal failure. However, other bone-toxic substances which accumulate in uremia (e. g., aluminum) may also contribute. The beneficial effect of calcitriol in renal osteodystrophy appears to result from correction of hypocalcemia and secondary hyperparathyroidism.
Alfacalcidol is used for the treatment of renal osteodystrophy, which is a metabolic bone disease that occurs in patients with renal failure. The main goal of treatment is to correct hypocalcemia and secondary hyperparathyroidism. 2
From the Research
Uses of Alfacalcidol
- Alfacalcidol is used in the treatment of osteoporosis, particularly in patients with glucocorticoid-induced osteoporosis 3, 4.
- It is also used to treat hyperparathyroidism and renal bone disease in patients with chronic kidney disease 5, 6.
- Alfacalcidol has been shown to be effective in increasing bone mineral density and reducing the risk of fractures in patients with osteoporosis 3, 4.
- It is also used to treat abnormalities in bone and mineral balance that arise in chronic kidney disease 6.
Comparison with Vitamin D
- Alfacalcidol has been shown to be more effective than plain vitamin D in the treatment of osteoporosis, particularly in patients with glucocorticoid-induced osteoporosis 3.
- Alfacalcidol has a more potent effect on bone mineral density and fracture risk reduction compared to vitamin D 4.
- Alfacalcidol is also more effective in suppressing parathyroid hormone secretion and reducing the risk of hyperparathyroidism compared to vitamin D 5.
Specific Patient Populations
- Alfacalcidol is used in patients with chronic kidney disease to treat hyperparathyroidism and renal bone disease 5, 6.
- It is also used in patients with osteoporosis, particularly those with glucocorticoid-induced osteoporosis 3, 4.
- Alfacalcidol may be used in patients with vitamin D deficiency, particularly those with osteomalacia 7.