Association of vitamin D deficiency, secondary hyperparathyroidism, and heterotopic ossification in spinal cord injury

Abstract

Abstract-Our objective was to explore the relationship between low vitamin D, secondary hyperparathyroidism, and heterotopic ossification (HO) in patients with spinal cord injury (SCI). Ninety-six subjects with acute or chronic motor complete SCI participated. Levels of serum vitamin D25(OH), calcium, and intact parathyroid hormone (PTH) were collected, and information regarding nutritional patterns and fracture history was obtained from subjects. Evidence of current or previous HO was ascertained through chart review. Of the 96 subjects, 12 were found to have developed HO, 11 with serum vitamin D25(OH) between 5 and 17 ng/mL. Nine subjects exhibited secondary hyperparathyroidism in the range of 72 to 169 pg/mL. Only one subject demonstrated HO in the absence of low vitamin D. However, many subjects with low vitamin D (5-31 ng/mL) did not have hyperparathyroidism or HO. Statistical testing demonstrated a correlation between hyperparathyroidism and HO (p < 0.001) as well as hyperparathyroidism and vitamin D deficiency (<20 ng/mL). Direct correlation between HO and low vitamin D was not observed, but hyperparathyroidism may increase this risk. We believe that those patients who demonstrate low vitamin D and elevated PTH should be screened for HO in addition to beginning vitamin supplementation. Initiating early treatment of low vitamin D to restore therapeutic levels may prevent development of HO.

Effect of 12-Week Vitamin D Supplementation on 25[OH]D Status and Performance in Athletes with a Spinal Cord Injury

“…In one study [39], over 80% of the participants remained insufficient after vitamin D supplementation with 2000 IU daily over a two-week period. Similar findings were shown with a supplementation of 800 IU daily over a duration of one year [39], and in a study where the compliance for taking vitamin D supplements was only at 72% [40]. Our study showed not only a high compliance but also that a dosage of 6000 IU vitamin D daily over six weeks would be sufficient to increase vitamin D status to a normal level.…”

“…Most of these studies failed to achieve a sufficient vitamin D status after the supplementation period [39,40]. In one study [39], over 80% of the participants remained insufficient after vitamin D supplementation with 2000 IU daily over a two-week period.…”

Correlations of serum level of 25(OH)D, Parathyroid Hormone (PTH) and Bone Mineral Density (BMD) among chronic patients of Spinal Cord Injury (SCI)

“…Oleson et al, 19 also reported their observations well in resonance to the present study. Gaspar AP et al 20 and Bauman WA et al, 16 observed that serum 25(OH)D level was positively correlated with the lumbar spine T score.…”

A rare presentation: A case report of osseous metaplasia and mature bone formation in a follicular adenoma of the thyroid

“…In the study of HO in spinal cord injury, 12 of the 96 subjects developed HO.12 Nine of these 12 had secondary hyperparathyroidism, with levels ranging from 72 to 169 pg/mL. A proposed mechanism is that parathyroid hormone (PTH) enhances BMP activity in premature osteoblasts which can lead to HO [12], [13]. A clinical review of literature done in 2013 states that twenty percent of spinal cord injuries exhibit HO afterwards.…”