The effects of vitamin D insufficiency in patients with primary hyperparathyroidism.

PURPOSE Differences in the prevalence of vitamin D deficiency may explain why the frequency of symptoms in patients with primary hyperparathyroidism varies geographically. This study was performed to determine the prevalence in the United States of low 25-hydroxyvitamin D levels among patients with mild primary hyperparathyroidism, and the effect of 25-hydroxyvitamin D status on disease severity. METHODS We studied 124 patients with mild primary hyperparathyroidism. Biochemical, bone mineral density, and bone histomorphometric indices were compared among patients whose serurm 25-hydroxyvitamin D levels were in the lowest and highest tertiles. RESULTS Serum 25-hydroxyvitamin D levels (mean +/- SD) were in the low range of normal (21 +/- 11 ng/mL, normal 9 to 52 ng/mL). Levels were below normal in 9 (7%) patients, and below the level suggested for vitamin D "sufficiency" (20 ng/mL) in 66 (53%) patients. Those with lowest 25-hydroxyvitamin D levels had the highest parathyroid hormone levels (low tertile 158 + 66 pg/mL versus high tertile 103 +/- 2 pg/mL, P <0.0001). Other evidence of more active hyperparathyroidism in those with low 25-hydroxyvitamin D levels included higher serum alkaline phosphatase activity (114 +/- 48 U/L versus 91 +/-35 U/L, P <0.03), lower serum phosphorus levels (2.7 +/- 0.4 mg/dL, versus 3.0 +/- 0.4 mg/dL, P <0.01), and greater bone mineral density at the lumbar spine (0.94 +/- 0.03 g/cm2 versus 0.83 +/- 0.03 g/cm2, P <0.05) reflecting the protective effects of parathyroid hormone on cancellous bone. They also had enhanced bone turnover on bone biopsy. Despite the expected differences in vitamin D metabolism in African-Americans, results did not differ by race. CONCLUSION Vitamin D insufficiency or deficiency is common among patients with mild primary hyperparathyroidism. In these patients, the effects of primary hyperparathyroidism on biochemical, densitometric, and histomorphometric indices are more pronounced.

[1]  L. Avioli,et al.  Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. , 1991, The Journal of clinical endocrinology and metabolism.

[2]  M. Chapuy,et al.  CHAPTER 66 – Vitamin D Insufficiency in Adults and the Elderly , 1997 .

[3]  S. Silverberg,et al.  Primary Hyperparathyroidism: Still Evolving? , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[4]  L. Sokoll,et al.  Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. , 1991, Annals of internal medicine.

[5]  M. Haussler,et al.  THE ASSAY OF 1α, 25‐DIHYDROXYVITAMIN D3: PHYSIOLOGIC AND PATHOLOGIC MODULATION OF CIRCULATING HORMONE LEVELS , 1976, Clinical endocrinology.

[6]  J. Berry,et al.  Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright © 1997 by The Endocrine Society Increased Catabolism of 25-Hydroxyvitamin D in Patients with Partial Gastrectomy and Elevated 1,25- Dihydroxyvitamin D Levels. Implications for Me , 2022 .

[7]  M. Chapuy,et al.  Calcium and vitamin D supplements: effects on calcium metabolism in elderly people. , 1987, The American journal of clinical nutrition.

[8]  H. van den Berg,et al.  Serum vitamin D concentrations among elderly people in Europe , 1995, The Lancet.

[9]  T. Clemens,et al.  Skeletal disease in primary hyperparathyroidism , 1989, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[10]  Keith C. Norris,et al.  Is the clinical expression of primary hyperparathyroidism a function of the long-term vitamin D status of the patient? , 1987, Mineral and electrolyte metabolism.

[11]  P. Delmas,et al.  Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. EPIDOS Study Group. , 1996, The Journal of clinical endocrinology and metabolism.

[12]  M. Drezner,et al.  Bone histomorphometry: Standardization of nomenclature, symbols, and units: Report of the asbmr histomorphometry nomenclature committee , 1987, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[13]  T. Helenius,et al.  SERUM LEVELS OF 25‐HYDROXYVITAMIN D, 24,25‐DIHYDROXYVITAMIN D AND PARATHYROID HORMONE IN PATIENTS WITH FEMORAL NECK FRACTURE IN SOUTHERN FINLAND , 1982, Clinical endocrinology.

[14]  T. Clemens,et al.  Serum vitamin D2 and vitamin D3 metabolite concentrations and absorption of vitamin D2 in elderly subjects. , 1986, The Journal of clinical endocrinology and metabolism.

[15]  L. Melton,et al.  Evidence for two distinct syndromes of involutional osteoporosis. , 1983, The American journal of medicine.

[16]  R. Nissenson,et al.  Effect of age on circulating immunoreactive and bioactive parathyroid hormone levels in women , 1987, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[17]  E. Delvin,et al.  Vitamin D nutritional status and related biochemical indices in an autonomous elderly population. , 1988, The American journal of clinical nutrition.

[18]  S. Silverberg,et al.  Optimal dietary calcium intake in primary hyperparathyroidism. , 1997, The American journal of medicine.

[19]  Brennan,et al.  Highly sensitive two-site immunoradiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemia. , 1987, Clinical chemistry.

[20]  F. Doyle,et al.  Vitamin-D deficiency and primary hyperparathyroidism. , 1971, Lancet.

[21]  P. Adams,et al.  The role of 1,25‐dihydroxyvitamin D in the mechanism of acquired vitamin D deficiency , 1992, Clinical endocrinology.

[22]  M. Holick,et al.  AGE, VITAMIN D, AND SOLAR ULTRAVIOLET , 1989, The Lancet.

[23]  M. Holick,et al.  Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. , 1998, The Journal of clinical endocrinology and metabolism.

[24]  M. McKenna,et al.  Differences in vitamin D status between countries in young adults and the elderly. , 1992, The American journal of medicine.

[25]  J. Goodwin,et al.  Nutritional status in a healthy elderly population: vitamin D. , 1982, The American journal of clinical nutrition.

[26]  J. Parks,et al.  New Insights into the Pathophysiology and Treatment of Nephrolithiasis: New Research Venues , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[27]  S. Stanbury,et al.  Parathyroid function in human vitamin D deficiency and vitamin D deficiency in primary hyperparathyroidism. , 1974, The American journal of medicine.

[28]  B. Dawson-Hughes,et al.  Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women , 1989, The New England journal of medicine.

[29]  G. D. Whedon,et al.  Vitamin D and bone health in the elderly. , 1982, The American journal of clinical nutrition.

[30]  M. Holick,et al.  Environmental factors that influence the cutaneous production of vitamin D 13 , 1995 .

[31]  Barrett T. Kitch,et al.  Hypovitaminosis D in medical inpatients. , 1998, The New England journal of medicine.

[32]  P. Delmas,et al.  The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. , 1988, The Journal of clinical endocrinology and metabolism.

[33]  R. Lindsay,et al.  The histomorphometry of bone in primary hyperparathyroidism: preservation of cancellous bone structure. , 1990, The Journal of clinical endocrinology and metabolism.

[34]  K. Becker,et al.  Principles and Practice of Endocrinology and Metabolism , 1990 .

[35]  H. Schmidt‐Gayk,et al.  Serum 25-hydroxycalciferol in myocardial infarction. , 1977, Atherosclerosis.