Skip to main content

Advertisement

SpringerLink
Log in

Skeletal effects of vitamin D deficiency among patients with primary hyperparathyroidism

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

Abstract

Summary

Little is known about the association between vitamin D deficiency and the skeletal phenotypes in primary hyperparathyroidism (PHPT) patients. A low 25-hydroxyvitamin D level was associated with a low bone mineral density and deteriorated hip geometry in women with PHPT in an Asian population where vitamin D deficiency is prevalent.

Introduction

Few studies have examined the effect of vitamin D deficiency on the bone health of primary hyperparathyroidism (PHPT) patients.

Methods

We investigated the skeletal effects of vitamin D deficiency in 79 PHPT patients by assessing bone mineral density (BMD), the trabecular bone score (TBS), and hip geometry, which were measured using dual-energy X-ray absorptiometry (27 men with median age 60 years [53;69]; 52 postmenopausal women with median age of 57 years [53;67]). Cross-sectional data were collected from subjects enrolled in an ongoing PHPT cohort study at Seoul National University Hospital from March 2008 to December 2015.

Results

We classified PHPT patients according to 25-hydroxyvitamin D (25(OH)D) levels (<20 vs. ≥20 ng/ml). After adjusting for age and body mass index, women with vitamin D deficiency had lower BMDs at the lumbar spine (LS) and femur neck (FN) than women who had sufficient levels of vitamin D (LS, 0.903 ± 0.138 vs. 0.998 ± 0.184 g/cm2; FN, 0.715 ± 0.084 vs. 0.791 ± 0.113 g/cm2; P < 0.05). However, the total hip BMD and the TBS were not significantly different between the two groups. In the hip geometry analysis, the cross-sectional area, cross-sectional moment of inertia, and section modulus were also significantly lower in women with vitamin D deficiency than in those without. No significant difference was found in the BMD, TBS, or hip geometry according to 25(OH)D levels in men.

Conclusion

Vitamin D deficiency may be associated with a low BMD and deteriorated hip geometry in postmenopausal women with PHPT.

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

References

  1. Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS, Melton LJ (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res 21:171–177

    Article  PubMed  Google Scholar 

  2. Christensson T, Hellström K, Wengle B, Alveryd A, Wikland B (1976) Prevalence of hypercalcaemia in a health screening in Stockholm. Acta Med Scand 200:131–137

    Article  CAS  PubMed  Google Scholar 

  3. Marcocci C, Cetani F (2011) Primary hyperparathyroidism. N Engl J Med 365:2389–2397

    Article  CAS  PubMed  Google Scholar 

  4. Witteveen J, van Thiel S, Romijn J, Hamdy N (2012) Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism. A systemic review of the literature. Eur J Endocrinol 168:R45–R53

    Article  Google Scholar 

  5. Moosgaard B, Vestergaard P, Heickendorff L, Melsen F, Christiansen P, Mosekilde L (2005) Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin Endocrinol 63:506–513

    Article  CAS  Google Scholar 

  6. Silverberg SJ (2007) Vitamin D deficiency and primary hyperparathyroidism. J Bone Miner Res 22(Suppl 2):V100–V104

    Article  CAS  PubMed  Google Scholar 

  7. Sahota O, Mundey M, San P, Godber I, Lawson N, Hosking D (2004) The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35:312–319

    Article  CAS  PubMed  Google Scholar 

  8. Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, Talpos GB, Parfitt AM (2000) Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 85:1054–1058

    CAS  PubMed  Google Scholar 

  9. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99:3561–3569

    Article  CAS  PubMed  Google Scholar 

  10. Woodhouse N, Doyle F, Joplin G (1971) Vitamin-D deficiency and primary hyperparathyroidism. Lancet 298:283–287

    Article  Google Scholar 

  11. Grey A, Lucas J, Horne A, Gamble G, Davidson JS, Reid IR (2005) Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab 90:2122–2126

    Article  CAS  PubMed  Google Scholar 

  12. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930

    Article  CAS  PubMed  Google Scholar 

  13. Litwic AE, Clynes M, Denison HJ, Jameson KA, Edwards MH, Sayer AA, Taylor P, Cooper C, Dennison EM (2016) Non-invasive assessment of lower limb geometry and strength using hip structural analysis and peripheral quantitative computed tomography: a population-based comparison. Calcif Tissue Int 98:158–164

    Article  CAS  PubMed  Google Scholar 

  14. Beck T (2003) Measuring the structural strength of bones with dual-energy X-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int 14(Suppl 5):S81–S88

    Article  PubMed  Google Scholar 

  15. International Society for Clinical Densitometry (2015) ISCD official positions: adult. http://www.iscd.org/official-positions/2015-iscd-official-positions-adult/ Accessed Nov 25 2016

  16. Stein EM, Dempster DW, Udesky J, Zhou H, Bilezikian JP, Shane E, Silverberg SJ (2011) Vitamin D deficiency influences histomorphometric features of bone in primary hyperparathyroidism. Bone 48:557–561

    Article  CAS  PubMed  Google Scholar 

  17. Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ, Silverberg SJ (2015) Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation. J Clin Endocrinol Metab 100:3443–3451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Walker MD, Nishiyama KK, Zhou B, Cong E, Wang J, Lee JA, Kepley A, Zhang C, Edward Guo X, Silverberg SJ (2016) Effect of low vitamin D on volumetric bone mineral density bone microarchitecture and stiffness in primary hyperparathyroidism. J Clin Endocrinol Metab 2015:4218

    Google Scholar 

  19. Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P (2014) Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial. J Clin Endocrinol Metab 99:1072–1080

  20. Kim H, Lee SH, Kim J, Lim KH, Ahn SH, Kim BJ, Koh JM (2015) The association of vitamin D with femoral neck strength: an additional evidence of vitamin D on bone health. J Clin Endocrinol Metab 100:3118–3125

  21. Hwang S, Choi HS, Kim KM, Rhee Y, Lim SK (2015) Associations between serum 25-hydroxyvitamin D and bone mineral density and proximal femur geometry in Koreans: the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2009. Osteoporos Int 26:163–171

  22. Martin EN, Haney EM, Shannon J, Cauley JA, Ensrud KE, Keaveny TM, Zmuda JM, Orwoll ES, Harrison SL, Marshall LM (2015) Femoral volumetric bone density, geometry, and strength in relation to 25-hydroxy vitamin D in older men. J Bone Miner Res 30:562–569

    Article  PubMed  Google Scholar 

  23. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP (2014) Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 29:518–530

    Article  PubMed  Google Scholar 

  24. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, Kim KJ, Rhee Y, Lim S-K (2010) Vitamin D insufficiency in Korea—a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 96:643–651

    Article  PubMed  Google Scholar 

  25. Clements M, Davies M, Fraser D, Lumb G, Mawer EB, Adams P (1987) Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism. Clin Sci (Lond) 73:659–664

    Article  CAS  Google Scholar 

  26. Bolland MJ, Grey AB, Gamble GD, Reid IR (2005) Association between primary hyperparathyroidism and increased body weight: a meta-analysis. J Clin Endocrinol Metab 90:1525–1530

    Article  CAS  PubMed  Google Scholar 

  27. Bringhurst FR, Demay MB, Kronenberg HM (2015) Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM (eds) Williams textbook of endocrinology, 13th edn. Elsevier, Philadelphia, pp 1271–1272

    Google Scholar 

  28. Powe CE, Evans MK, Wenger J et al (2013) Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med 369:1991–2000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Gough IR, Balderson GA, Lloyd HM, Galligan J, Willgoss D, Fryar BG (1988) The effect of intravenous magnesium sulphate on parathyroid function in primary hyperparathyroidism. World J Surg 12:463–468

    Article  CAS  PubMed  Google Scholar 

  30. Khosla S, Melton LJ 3rd, Riggs BL (2011) The unitary model for estrogen deficiency and the pathogenesis of osteoporosis: is a revision needed? J Bone Miner Res 26:441–451

    Article  CAS  PubMed  Google Scholar 

  31. Gennari C, Agnusdei D, Nardi P, Civitelli R (1990) Estrogen preserves a normal intestinal responsiveness to 1, 25-dihydroxyvitamin D3 in oophorectomized women. J Clin Endocrinol Metab 71:1288–1293

    Article  CAS  PubMed  Google Scholar 

  32. Ooms MELP, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, Bouter LM (1995) Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 10:1177–1184

    Article  CAS  PubMed  Google Scholar 

  33. Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Seoul National University Hospital Research Fund (Grant No. 1306-101-499).

Author information

Author notes

    Authors and Affiliations

    1. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

      J. H. Lee, J. H. Kim, A. R. Hong, S. W. Kim & C. S. Shin

    Authors
    1. J. H. Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. J. H. Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. A. R. Hong
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. S. W. Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. C. S. Shin
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to C. S. Shin.

    Ethics declarations

    This study was approved by the Seoul National University Hospital Institutional Review Board (no. 1306-101-499) and informed consent was waived due to the retrospective cohort design.

    Conflict of interest

    None.

    Additional information

    Ji Hyun Lee and Jung Hee Kim contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lee, J.H., Kim, J.H., Hong, A.R. et al. Skeletal effects of vitamin D deficiency among patients with primary hyperparathyroidism. Osteoporos Int 28, 1667–1674 (2017). https://doi.org/10.1007/s00198-017-3918-2

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00198-017-3918-2

    Keywords

    Search

    Navigation