Skip to main content

Advertisement

SpringerLink
Log in

Variations in parathyroid hormone concentration in patients with low 25 hydroxyvitamin D

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Although 25 hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels are inversely related, less than half of the patients with a low vitamin D level have an elevated PTH, and, in most of these patients, the PTH does not immediately normalize with correction of the vitamin D.

Introduction

Despite the inverse relationship between 25OHD and PTH, patients with vitamin D deficiency seen in clinical practice do not always have an elevated PTH, and, in those with secondary hyperparathyroidism, the PTH does not always normalize with correction of vitamin D deficiency. We examined variations in PTH concentrations in patients with low 25OHD and studied changes in the PTH concentration with restoration of vitamin D sufficiency.

Methods

This was a retrospective cohort study of patients with a 25OHD < 30 ng/mL and a concomitant PTH measurement seen at the Metabolic Bone Disease Clinic at a tertiary care center between July 1, 2007 and May 31, 2011. Patients with conditions associated with alterations in PTH were excluded.

Results

The study population consisted of 104 patients. The mean age was 55.5 years, and 83 % were female. The 25OHD and PTH were negatively correlated, but only 30 % of patients with a 25OHD < 30 ng/mL and 40 % of those with a 25OHD < 20 ng/mL had an elevated PTH. As the 25OHD increased to 30 ng/mL or higher, the PTH decreased significantly in the group of patients who had an elevated PTH at baseline, but only 44 % reached a normal PTH. Of patients with a normal PTH at baseline, 59 % experienced a drop in their PTH while the PTH remained unchanged or increased in 41 %.

Conclusions

PTH has a limited role in defining vitamin D status in individual patients and in guiding vitamin D therapy in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

25OHD:

25 Hydroxyvitamin D

ASR:

Amal Shibli-Rahhal

BP:

Bhanu Paturi

EMR:

Electronic medical record

PTH:

Parathyroid hormone

SAS:

Statistical analysis system

References

  1. Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE (2005) Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224

    Article  CAS  PubMed  Google Scholar 

  2. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783

    Article  CAS  PubMed  Google Scholar 

  3. Ginde AA, Wolfe P, Camargo CA Jr, Schwartz RS (2012) Defining vitamin D status by secondary hyperparathyroidism in the US population. J Endocrinol Invest 35:42–48

    CAS  PubMed  Google Scholar 

  4. IOM (Institute of Medicine) (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, D.C., pp 260–262

    Google Scholar 

  5. Naveh-Many T, Friedlaender MM, Mayer H, Silver J (1989) Calcium regulates parathyroid hormone messenger ribonucleic acid (mRNA), but not calcitonin mRNA in vivo in the rat. Dominant role of 1,25-dihydroxyvitamin D. Endocrinology 125:275–280

    Article  CAS  PubMed  Google Scholar 

  6. Brown EM (1983) Four-parameter model of the sigmoidal relationship between parathyroid hormone release and extracellular calcium concentration in normal and abnormal parathyroid tissue. J Clin Endocrinol Metab 56:572–581

    Article  CAS  PubMed  Google Scholar 

  7. Haden ST, Brown EM, Hurwitz S, Scott J, El-Hajj Fuleihan G (2000) The effects of age and gender on parathyroid hormone dynamics. Clin Endocrinol (Oxf) 52:329–338

    Article  CAS  Google Scholar 

  8. Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ, EPIDOS Study Group (1996) Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 81:1129–1133

    CAS  PubMed  Google Scholar 

  9. Okazaki R, Sugimoto T, Kaji H, Fujii Y, Shiraki M, Inoue D, Endo I, Okano T, Hirota T, Kurahashi I, Matsumoto T (2011) Vitamin D insufficiency defined by serum 25-hydroxyvitamin D and parathyroid hormone before and after oral vitamin D3 load in Japanese subjects. J Bone Miner Metab 29:103–110

    Article  CAS  PubMed  Google Scholar 

  10. Bacon CJ, Woo J, Lau MC, Lam CWK, Gamble GD, Reid IR (2010) Effects of 25-hydroxyvitamin D level and its change on parathyroid hormone in premenopausal Chinese women. Osteoporos Int 21:1935–1941

    Article  CAS  PubMed  Google Scholar 

  11. Ardawi M-S M, Sibiany AM, Bakhsh TM, Qari MH, Maimani AA (2011) High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors. Osteoporos Int 23:675–686

    Article  PubMed  Google Scholar 

  12. Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G (2012) PTH level but not 25 (OH) vitamin D predicts bone loss rates in the elderly. Osteoporos Int 23:971–980

    Article  CAS  PubMed  Google Scholar 

  13. González-Molero I, Morcillo S, Valdés S, Pérez-Valero V, Botas P, Delgado E, Hernández D, Olveira G, Rojo G, Gutierrez-Repiso C, Rubio-Martín E, Menéndez E, Soriguer F (2011) Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 65:321–328

    Article  PubMed  Google Scholar 

  14. Kuchuk NO, Pluijm SMF, van Schoor NM, Looman CWN, Smit JH, Lips P (2009) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94:1244–1250

    Article  PubMed  Google Scholar 

  15. Sheikh A, Saeed Z, Jafri SA, Yazdani I, Hussain SA (2012) Vitamin D levels in asymptomatic adults—a population survey in Karachi, Pakistan. PloS One 7:e33452

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D, Nickelsen T (2001) A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 86:1212–1221

    Article  CAS  PubMed  Google Scholar 

  17. Holick MF (2009) Vitamin D status: measurement, interpretation and clinical application. Ann Epidemiol 19:73–78

    Article  PubMed Central  PubMed  Google Scholar 

  18. Singh RJ, Taylor RL, Reddy GS, Grebe SK (2006) C-3 epimers can account for a significant proportion of total circulating 25-hydroxyvitamin D in infants, complicating accurate measurement and interpretation of vitamin D status. J Clin Endocrinol Metab 91:3055–3061

    Article  CAS  PubMed  Google Scholar 

  19. Joly D, Drueke TB, Alberti C, Houillier P, Lawson-Body E, Martin KJ, Massart C, Moe SM, Monge M, Souberbielle JC (2008) Variation in serum and plasma PTH levels in second-generation assays in hemodialysis patients: a cross-sectional study. Am J Kidney Dis 51:987–995

    Article  CAS  PubMed  Google Scholar 

  20. Cavalier E, Carlisi A, Bekaert AC, Rousselle O, Chapelle JP, Delanaye P (2012) New insights on the stability of the parathyroid hormone as assayed by an automated 3rd generation PTH assay. Clin Chim Acta 413:353–354

    Article  CAS  PubMed  Google Scholar 

  21. Cavalier E, Delanaye P, Hubert P, Krzesinski JM, Chapelle JP, Rozet E (2009) Estimation of the stability of parathyroid hormone when stored at −80 degrees C for a long period. Clin J Am Soc Nephrol 4:1988–1992

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Heaney RP, Saville PD, Recker RR (1975) Calcium absorption as a function of calcium intake. J Lab Clin Med 85:881–890

    CAS  PubMed  Google Scholar 

  23. Adami S, Viapiana O, Gatti D, Idolazzi L, Rossini M (2008) Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. Bone 42:267–270

    Article  CAS  PubMed  Google Scholar 

  24. Rude RK, Oldham SB, Singer fR (1986) Functional hypoparathyroidism and parathyroid hormone end-organ resistance in human Mg deficiency. Clin Endocrinol 5:209–224

    Article  Google Scholar 

  25. Sahota O, Mundey MK, San P, Godber IM, Hosking DJ (2006) Vitamin D insufficiency and the blunted PTH response in established osteoporosis: the role of magnesium deficiency. Osteoporos Int 17:1013–1021

    Article  CAS  PubMed  Google Scholar 

  26. Giusti A, Barone A, Pioli G, Girazoli G, Razzano M, Pizzonia M, Pedrazzoni M, Palummeri E, Bianchi G (2010) Heterogeneity in serum 25-hydroxy-vitamin D response to cholecalciferol in elderly women with secondary hyperparathyroidism and vitamin D deficiency. J Am Geriatr Soc 58:1489–1495

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    A. Shibli-Rahhal

  2. Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Saint Francis Medical Center, Peoria, IL, USA

    B. Paturi

  3. Joslin Diabetes Center, Peoria, IL, USA

    B. Paturi

  4. Division of Endocrinology, E 426 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    A. Shibli-Rahhal

Authors
  1. A. Shibli-Rahhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Paturi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Shibli-Rahhal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shibli-Rahhal, A., Paturi, B. Variations in parathyroid hormone concentration in patients with low 25 hydroxyvitamin D. Osteoporos Int 25, 1931–1936 (2014). https://doi.org/10.1007/s00198-014-2687-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-014-2687-4

Keywords

Search

Navigation