| Summary: | BACKGROUND: Calcitriol has long been shown to be an effective therapy in the management of osteoporosis and renal osteodystrophy.However, it carries the potential risk of causing hypercalcemia and hyperphosphatemia when used without proper monitoring. It is also a costly drug. In recent years, the usage of calcitriol in University Malaya Medical Centre (UMMC) has shown a huge increase.
OBJECTIVES: To define the characteristics of patients prescribed with calcitriol, to determine if monitoring parameters were done following therapy initiation and to assess the adherence of calcitriol prescribing to standard practice guidelines.
MATERIALS AND METHODS: A retrospective review of 200 medical records of patients initiated with calcitriol therapy from January 2002 to December 2003 was done. An analysis of indications and demographic characteristics was done to describe the prescribing pattern. Type and frequency of monitoring before and after therapy initiation were also assessed. Adherence to guidelines was assessed using the Osteoporosis Malaysian guidelines and the Malaysian Renal Replacement Therapy guidelines as references.
RESULTS: Majority of patients who were initiated calcitriol were Chinese (60%) and female (96.5%) with the mean age of 56.6 ± 14.5 years.Most patients, 180 (90%) received calcitriol for the management of various types of osteoporosis. Its use for the prevention of postmenopausal osteoporosis was most common (56%). Of these 180 patients, bone mineral density (BMD) results were found to be osteoporotic in 15.6%, osteopenic in 28.3% and normal in 7.8%. Almost half of them (48.3%) had no BMD measurements done prior to calcitriol initiation. Only 60 patients (30%) had subsequent bone profiles or serum calcium done after calcitriol initiation. Adherence to the Malaysian Osteoporosis and Renal Replacement Therapy guidelines were only 29% and 14.3% respectively.
CONCLUSION: The prescribing of calcitriol can be improved in UMMC by preventing its use for unclear indications. Follow-up laboratory monitoring is also important to prevent the development of side effects.
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