Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture

Abstract

oBjEcTIVE: hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (pTh). we hypothesized that bone mineral density (BMD) could be lower in patients with high pTh levels than in those with normal levels of pTh, irrespectively of the severity of vitamin D depletion. DEsIgn: In this cross-sectional study, we examined 405 women who had serum 25-hydroxyvitamin D below 12ng/ml 20.0 ± 5.9 (mean ± sD) days after a hip-fracture. pTh was assessed by a chemiluminescent immunometric assay and BMD by dual-energy x-ray absorptiometry at the unfractured femoral neck. rEsulTs: BMD was significantly lower in the 148 women with secondary hyperparathyroidism than in the 257 with normal pTh levels: the mean T-score (sD) was -2.88 (0.93) and -2.65 (0.83), respectively, in the two groups (mean difference 0.23; 95% cI 0.05 -0.41; p = 0.010). The association between pTh status and BMD persisted after adjustment for age, body mass index, phosphate, albumin-adjusted total calcium, 25-hydroxyvitamin D, estimated glomerular filtration rate, and magnesium (p=0.01). The presence of secondary hyperparathyroidism was significantly associated with a femoral neck T-score lower than -2.5. The adjusted odds ratio was 1.81 (95% cI 1.11 -2.95; p=0.017). conclusIons: our results show that pTh levels in the presence of severe vitamin D deficiency were significantly associated with femoral BMD in women with hip-fracture. prevention and treatment of vitamin D deficiency may be particularly relevant in women who develop secondary hyperparathyroidism.

Evaluation of Serum 25‐Hydroxyvitamin D3 and Bone Mineral Density in 268 Patients with Hip Fractures

“…Although PTH levels were elevated, only 86 patients (32.09%) had PTH values above the upper limit of normal (76.8 pg/mL), consistent with previous studies 18 . Monaco et al 19 . also found 148 patients (37%) with secondary PTH elevation in 405 hip patients studied; 63% had severe vitamin D deficiency, but PTH was within the normal range.…”

“…Logistic multivariate analysis in this study revealed that gender and BMI were independent risk factors for BMD. Compared with men, the T‐values of BMD in all parts of women were significantly lower, which was related to the decrease of estrogen, a hormone that inhibits osteoclast, in postmenopausal women 16, 19 . It might also be related to the lower proportion of vitamin D deficiency in men than in women.…”

“…The effect of PTH on bone density remains controversial. Monaco et al 19 . found that BMD values were significantly lower in the secondary high PTH group compared with the normal PTH group.…”

D-vítamínbúskapur íslenskra barna og ungmenna: Langtímarannsókn

“…33 Einstaklingar með lága þéttni D-vítamíns ásamt háu S-PTH gildi hafa að meðaltali laegri beinþéttni en þeir sem eru með lága D-vítamínþéttni en eðlilegt S-PTH og þeir sem hafa eðlilegt S-PTH eru síður líklegir til að detta og að fá laerhnútubrot, samanborið við þá sem hafa hátt S-PTH þrátt fyrir lága D-vítamínþéttni. 34,35 Einnig hefur S-PTH verið tengt við langvarandi bólgur í líkamanum 36 og lifun eldra fólks með lága D-vítamínþéttni er verri ef S-PTH er hátt. 37 Hátt S-PTH hefur einnig jákvaeða fylgni við blóðþurrðarsjúkdóma og stífleika í ósaeð.…”

Association of Vitamin D Deficiency with Low Serum Albumin in Taiwanese Older Adults with Hip Fracture: A Prospective Cross-Sectional Study

“…It increases serum calcium concentration by inducing proteins involved in active intestinal cal-cium absorption and stimulates bone calcium mobilization if the dietary intake of calcium is poor. Vitamin D deficiency causes hyperparathyroidism, which increases bone turnover and accelerates bone loss, resulting in an elevated fracture risk (4). 25(OH)D is also a prognostic predictor of functional recovery following hip fracture (5).…”