Association of Vitamin D and Parathyroid Hormone Status With the Aging-Related Decline of Bone Microarchitecture in Older Men: The Prospective Structure of Aging Men's Bones (STRAMBO) Study

Abstract

Poor vitamin D status and high parathyroid hormone (PTH) level are associated with impaired bone microarchitecture, but these data are mainly cross-sectional. We studied the association of the baseline PTH and 25-hydroxycholecalciferol (25OHD) levels with the prospectively assessed deterioration of bone microarchitecture and in estimated bone strength in older men. Distal radius and tibia bone microarchitecture was assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline, then after 4 and 8 years in 826 men aged 60-87 years. At distal radius, total bone mineral density (Tt.BMD), cortical thickness (Ct.Th d ), cortical area (Ct.Ar), cortical BMD (Ct.BMD), and trabecular BMD (Tb.BMD) decreased, whereas trabecular area (Tb.Ar) increased more rapidly in men with 25OHD ≤20 ng/mL versus the reference group (>30 ng/mL). Men with 25OHD ≤10 ng/mL had faster decrease in reaction force and failure load than men with 25OHD >30 ng/mL. At the distal tibia, Tt.BMD, Ct.Th d , Ct.Ar, Ct.BMD, failure load, and reaction force decreased, whereas Tb.Ar increased more rapidly in men with 25OHD between 10 and 20 ng/mL versus the reference group. The results were similar when 12 ng/mL was used as a threshold of severe vitamin D deficiency. At distal radius, men with PTH levels above the median (>44 pg/mL) had more rapid decrease in Tt.BMD, Ct.Ar, Ct.BMD, Ct.Th d , reaction force, and failure load, and more rapid increase in Tb.Ar versus the lowest quartile (≤34 pg/mL). At the distal tibia, men in the highest PTH quartile had faster decrease in Tt.BMD, Ct.Th d , Ct.Ar, Ct.BMD, reaction force, and failure load and faster increase in Tb.Ar versus the lowest quartile. The results were similar in men with glomerular filtration rate >60 mL/min. The results were similar in men who took no vitamin D or calcium supplements for 8 years. In summary, vitamin D deficiency and secondary hyperparathyroidism are associated with more rapid prospectively assessed cortical and trabecular bone decline in older men.

Associations Between Aldosterone-Renin-Ratio and Bone Parameters Derived from Peripheral Quantitative Computed Tomography and Impact Microindentation in Men

“…However, compared to men without likely primary aldosteronism, those with likely primary aldosteronism had lower vitamin D. For the group of men meeting the definition for possible primary aldosteronism, there was a trend towards elevated parathyroid hormone and lower vitamin D. Similar observations with elevated parathyroid hormone and reduced vitamin D for individuals with primary aldosteronism have also been reported in other studies [ 6 , 9 , 10 ]. Additionally, a clinical trial [ 30 ] following men over an 8 year period, showed that for those with vitamin D deficiency (≤ 20 ng/mL), total BMD, cortical BMD, cortical area and cortical thickness measured using high-resolution pQCT at the distal radius all declined faster over time than for men with sufficient vitamin D. The study also reported that men in the two highest quartiles of parathyroid hormone had a faster decline in total BMD, cortical thickness, cortical area and cortical BMD at the distal radius than those in the lowest quartile of parathyroid hormone.…”

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“…Moreover, Vitamin D and PTH levels are crucial for bone mineral density and turnover, especially in osteoporosis, a condition that shares several pathophysiological pathways with osteoarthritis [ 4 ]. The association of these factors with bone microarchitecture in the aging population further underlines their importance in conditions like osteoarthritis [ 5 ].…”