Parathyroid hormone response to two levels of vitamin D deficiency is associated with high risk of medical problems during hospitalization in patients with hip fracture

Background:Primary hyperparathyroidism (PHPT) is a common endocrine condition, commonly seen with increasing age. In vast majority, it is diagnosed incidentally and causes no particular symptoms. Symptoms are usually related to acute hypercalcaemia or the complications of chronically elevated serum calcium level. Vitamin D deficiency is common among general population and in patients with PHPT. Studies in secondary hyperparathyroidism (SHPT) have shown that parathyroid hormone (PTH) response is affected by age, with those over 80 showing greater rise in PTH levels. We wanted to see if age has a similar impact on PTH response to vitamin D in those with PHPT.Objectives:To evaluate the impact of age on PTH response to vitamin D insufficiency in those with PHPT.Methods:Patients with primary hyperparathyroidism (PHPT), attending general endocrine clinic of a district general hospital, were divided into two groups based on age; less than 70 (n=73) and 70 and above (n=61).Each group was subdivided into vitamin D insufficient (VDI) and vitamin D sufficient (VDS) subgroups. We compared calcium and parathyroid hormone levels and forearm BMD (presented as T score) in VDI and VDS subgroups in the two age groups, at the time of diagnosis. Data were analyzed using unpaired t-test and presented as mean ± SEM, using Graphpad Prism 9.0.1.Results:There was significant difference in Vitamin D levels in VDI and VDS subgroups, in both age groups (<70; mean vitamin D 27.98 vs. 68.44, p<0.0001; ≥70; mean vitamin D 34.44 vs. 75.74, p<0.0001). The two groups were significantly different in terms of age (mean age 58 vs. 76, p<0.0001). Although there was no difference in calcium and forearm BMD in VDI and VDS, in both age groups, those under 70 showed a greater PTH response to vitamin D insufficiency (mean PTH 19.29 vs. 12.91 respectively, p<0.001).Conclusion:While in SHPT, those with increasing age show greater rise in PTH levels, our data show that in PHPT, younger patients show a greater PTH rise in response to vitamin D insufficiency. Further work is needed to elucidate the underlying mechanisms.References:[1]Wyskida et al., Parathyroid hormone response to different vitamin D levels in population-based old and very-old Polish cohorts, Experimental Gerontology, Volume 127, 2019, 110735, ISSN 0531-5565, https://doi.org/10.1016/j.exger.2019.110735.[2]Malik M Z, Latiwesh O B, Nouh F, et al. (August 15, 2020) Response of Parathyroid Hormone to Vitamin D Deficiency in Otherwise Healthy Individuals. Cureus 12(8): e9764. doi:10.7759/cureus.9764Disclosure of Interests:None declared.

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Vitamin D Deficiency and Seasonal and Inter-day Variation in Circulating 25-hydroxyvitamin D and Parathyroid Hormone Levels in Indoor Daytime Workers: A Longitudinal Study

Industrial Health ◽

10.2486/indhealth.ms1255 ◽

2011 ◽

Vol 49 (4) ◽

pp. 475-481 ◽

Cited By ~ 15

Author(s):

Hiroaki ITOH ◽

Ippei MORI ◽

Yuki MATSUMOTO ◽

Syou MAKI ◽

Yasutaka OGAWA

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Longitudinal Study ◽

Vitamin D Deficiency ◽

Hormone Levels ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

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Vitamin D and Cardiovascular Disease: An Updated Narrative Review

International Journal of Molecular Sciences ◽

10.3390/ijms22062896 ◽

2021 ◽

Vol 22 (6) ◽

pp. 2896

Author(s):

Armin Zittermann ◽

Christian Trummer ◽

Verena Theiler-Schwetz ◽

Elisabeth Lerchbaum ◽

Winfried März ◽

...

Keyword(s):

Cardiovascular Disease ◽

Vitamin D ◽

High Risk ◽

General Population ◽

Vitamin D Deficiency ◽

Specific Gene ◽

Vitamin D Status ◽

Cvd Risk ◽

Severe Vitamin ◽

Increased Risk

During the last two decades, the potential impact of vitamin D on the risk of cardiovascular disease (CVD) has been rigorously studied. Data regarding the effect of vitamin D on CVD risk are puzzling: observational data indicate an inverse nonlinear association between vitamin D status and CVD events, with the highest CVD risk at severe vitamin D deficiency; however, preclinical data and randomized controlled trials (RCTs) show several beneficial effects of vitamin D on the surrogate parameters of vascular and cardiac function. By contrast, Mendelian randomization studies and large RCTs in the general population and in patients with chronic kidney disease, a high-risk group for CVD events, largely report no significant beneficial effect of vitamin D treatment on CVD events. In patients with rickets and osteomalacia, cardiovascular complications are infrequently reported, except for an increased risk of heart failure. In conclusion, there is no strong evidence for beneficial vitamin D effects on CVD risk, either in the general population or in high-risk groups. Whether some subgroups such as individuals with severe vitamin D deficiency or a combination of low vitamin D status with specific gene variants and/or certain nutrition/lifestyle factors would benefit from vitamin D (metabolite) administration, remains to be studied.

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