Calcitriol for Osteitis Fibrosa

To the Editor: The article by Andress et al. (Aug. 3 issue)¹ shows that refractory osteitis fibrosa in patients on long-term hemodialysis can be treated effectively with intravenous calcitriol. We are, however, a little concerned about the actual long-term clinical benefit of such an approach for the following reasons. Although dramatic, the decrease in the histologic values resolved the hyperparathyroidism in only about half the patients, and the mean alkaline phosphatase level remained more than twice the upper limit of normal, showing that the success was far from complete. As stressed by Malluche and Faugere² in the accompanying editorial, the….