P114 Effect of vitamin D on parathyroid hormone, serum calcium and bone mineral density in patients with primary hyperparathyroidism being managed conservatively

Abstract Background/Aims Vitamin D deficiency is associated with more severe presentation of primary hyperparathyroidism (PTHP) with high parathyroid hormone (PTH) levels and reduced bone mineral density (BMD). We analyzed data to determine if vitamin D levels had any impact on PTH, serum calcium and BMD at diagnosis and 3 years, in patients being managed conservatively. Methods Retrospective analysis of patients presenting with PHPT. Based on vitamin D level at diagnosis, patients were divided into two groups; vitamin D sufficient (≥ 50 nmol/L) and vitamin D insufficient (≤ 50 nmol/L). The two groups were compared for age, serum calcium and PTH levels at diagnosis and after mean follow up of 3 years. BMD at forearm and neck of femur (NOF) was only analyzed in the two groups at diagnosis, due to lack of 3 year’s data. Results There were a total of 93 patients, 17 males, mean age 70; range 38-90. Mean vitamin D level was 73.39 nmol/L in sufficient group (n = 42) and 34.48 nmol/L in insufficient group (n = 40), (difference between means -38.91, 95% confidence interval -45.49 to -32.33, p < 0.0001). There was no significant difference in age, serum calcium and PTH at the time of diagnosis. After three years, there was no significant difference in vitamin D levels between the two groups (mean vitamin D 72.17 nmol/L in sufficient group and 61.48 nmol/L in insufficient group). Despite rise in vitamin D level in insufficient group, no significant change was observed in this group in PTH and serum calcium levels. BMD was lower at both sites in vitamin D sufficient group and difference was statistically significant at NOF. Data were analyzed using unpaired t test and presented as mean ± SEM. Conclusion 50% of patients presenting with PHPT were vitamin D insufficient at diagnosis. Vitamin D was adequately replaced so that at 3 years there was no significant difference in vitamin D status in the two groups. Serum calcium and PTH were no different in the two groups at diagnosis and at three years, despite rise in vitamin D levels in the insufficient group. Interestingly, BMD was lower at forearm and neck of femur in those with sufficient vitamin D levels and the difference was statistically significant at neck of femur. Our data show that vitamin D insufficiency does not have any significant impact on PTH and calcium levels and that vitamin D replacement is safe in PHPT and does not impact serum calcium and PTH levels in the short term. Lower BMD in those with adequate vitamin D levels is difficult to explain and needs further research. Disclosure M. Khalid: None. V. Deshani: None. K. Jadoon: None.

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Screening for Vitamin D Deficiency in Black Americans: Comparison of Total, Free, Bioavailable 25 Hydroxy Vitamin D Levels with Parathyroid Hormone Levels and Bone Mineral Density

The journal of nutrition health & aging ◽

10.1007/s12603-018-1080-y ◽

2018 ◽

Vol 22 (9) ◽

pp. 1045-1050 ◽

Cited By ~ 2

Author(s):

Alexis McKee ◽

S. M. Lima Ribeiro ◽

T. K. Malmstrom ◽

H. M. Perry ◽

D. K. Miller ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Parathyroid Hormone ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Black Americans ◽

Mineral Density ◽

Hormone Levels ◽

Vitamin D Levels ◽

25 Hydroxy Vitamin D

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Juvenile lupus and serum vitamin D levels: A cross-sectional study

Lupus ◽

10.1177/0961203320957721 ◽

2020 ◽

Vol 29 (13) ◽

pp. 1752-1758

Author(s):

Samar abd Alhamed Tabra ◽

Hend Hassan Abdelnabi ◽

Nivine Fathi Mahmoud Darwish ◽

Amal Mohammed El-Barbary ◽

Muhammad Tarek AbdelGhafar ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Healthy Children ◽

Z Score ◽

Mineral Density ◽

Vitamin D Levels ◽

Significant Difference

Background Juvenile systemic lupus erythematosus (JSLE) is usually associated with vitamin D deficiency and low bone mineral density. Objectives To evaluate serum levels of 25-OH vitamin D in JSLE patients and to correlate these findings with disease activity and bone density. Methods This study was conducted on 100 patients with JSLE and 100 healthy children as controls. Disease duration and SLEDAI for disease activity were evaluated. CBC, anti-dsDNA, C3,C4,24hr urinary proteins, creatinine, estimated glomerular filtration rate(e-GFR),Ca,P,PTH, 25 (OH) D levels, and bone mineral density(BMD)Z score were measured. Results There were significant differences in mean 25(OH)D concentration between patients group (19.37 ± 9.72 ng/ml) and controls 35.90 ± 9.66 ng/ml(p < 0.05), with significant difference between active and inactive patients (p < 0.05).There were significant negative correlations between serum 25(OH)D and SLEDAI (r-0.545, p 0.001), steroid dose (r-0.561, p 0.001), anti-dsDNA (r-0.685, p 0.006), 24 hr-proteinuria (r-0.738, p 0.001) and PTH (r-0.335, p 0.001), significant positive correlations between 25(OH)D and C3 (r0.617, p 0.001),C4 (r0.544, p 0.001) serum Ca (r0.424, p 0.001) and Z score (r0.561, p 0.001),with non-significant correlations between 25(OH)D and serum P and both disease & steroid duration, (p > 0.05). Conclusion Vitamin D deficiency is common in JSLE, it’s correlated significantly with disease activity and bone mineral density.

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Comparison of Bone Mineral Density with Biochemical Parameters and Prevalence of Osteopenia and Osteoporosis in South Indian Population

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1603 ◽

2018 ◽

Vol 11 (4) ◽

pp. 2209-2214

Author(s):

P. Modagan ◽

Santhi Silambanan ◽

P. Gopinath Menon ◽

P. Arunalatha

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Bone Mineral ◽

Serum Calcium ◽

Biochemical Markers ◽

South Indian Population ◽

Mineral Density ◽

Group I ◽

Vitamin D Levels ◽

25 Oh Vitamin D

Osteoporosis is identifying based on the bone mineral density (BMD). The bone mineral mass or BMD exposes the amount of minerals present in a particular region of bone tissue. BMD measurement by DEXA is consideredas gold standard, but it is very expensive. The people of developing countriesare not interested to check BMD until the occurrence offracture. Therefore present study focusing any association of routine biochemical markers with BMD in osteoporosis and also planning to identify disease distribution status in south India. We examined 773 participants BMD by DEXA scan and grouped into three, Group I (Normal bone mass, n=237), group II (Osteopenia, n=345) and group III (Osteoporosis, n=191). The serum calcium, phosphorous and alkaline phosphatase (ALP) were estimated by automated chemistry analyzer., and Serum 25(OH) vitamin D was analyzed by immunoassay system analyser. The prevalence of normal BMD, osteopenia and osteoporosis was 30.7%, 44.6%and 24.7% respectively.Between 60 and 69 years aged men having more prevalence of osteopenia and in women 50 to 59 years of age. While osteoporosis in men 50 to 59 years and in women’s were 60 to 69 years of age. The serum calcium, ALP and 25 (OH) vitamin D levels were statistically significant (p< 0.001) between the three groups.The higher percentage of low bone mineral density (osteopenia) is the alarming signalto the bone health and this could be continued leads to osteoporosis, which affects the quality of life. This study suggests to determining BMD along with biochemical markers are useful to identify osteoporosis in earlier stage. Therefore routine screening of BMD may prevent the risk of osteoporosis.

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Levetiracetam monotherapy effect on serum calcium and serum vitamin D in patient of epilepsy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170140 ◽

2017 ◽

Vol 5 (2) ◽

pp. 503 ◽

Cited By ~ 1

Author(s):

Anubha Garg ◽

Surekha Dabla ◽

Sandeep Nagenhalli ◽

Sanjay Fotedar

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Bone Mineral ◽

Serum Calcium ◽

Serum Vitamin ◽

Total Leukocyte Count ◽

Mineral Density ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

One Year

Background: Objective of the study was to determine the Levetiracetam monotherapy effect on serum calcium and serum vitamin D levels in tertiary care hospital in Haryana, India.Methods: A total of 110 patients with epilepsy, were enrolled to the study for one year between April 2013 to August 2014. All male patients aged 15-60 years and premenopausal females with epilepsy were included in the study. The study was a interventional prospective study design. The antiepileptic drug levetiracetam was administered starting from a dose of 20 mg/kg and dose was titrated according to the clinical response. During the follow up period, the subjects were asked about the seizure frequency and other side effects. The patients were be subjected to questionnaires based proforma. Baseline investigations, Hemogram, renal and liver function tests, calcium, phosphate, vitamin D and bone mineral density and T scores were noted. All investigations were repeated after one year of levetiracetam monotherapy.Results: The mean age of onset of seizures in the study group was 23.22±6.62 years. 58% (n=29) were seizure free after 1 year of levetiracetam monotherapy, 28% patients had adequate control and 14% patients had poor control of their seizure episodes. There was an insignificant change in Hemoglobin, total leukocyte count, platelet count, renal parameters and Liver enzymes from baseline over a year of levetiracetam therapy. Serum calcium levels increased insignificantly from baseline levels of 9.68±0.59 mg/dl to 9.72±0.56mg/dl. Vitamin D levels increased from baseline of 39.35±14.91ng/ml to 39.84±14.07 ng/ml. Bone mineral density increased insignificantly from baseline of 0.92±0.13 g/cm2 to 0.93±0.13 g/cm2.Conclusions: Present study has shown an overall beneficial effect on serum calcium, Vitamin D level, bone mineral density and T scores on DEXA scan.

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Comparison of Bone Mineral Density in Thalassemia Major Patients with Healthy Controls

Advances in Hematology ◽

10.1155/2015/648349 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Mahesh Chand Meena ◽

Alok Hemal ◽

Mukul Satija ◽

Shilpa Khanna Arora ◽

Shahina Bano

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Bone Mineral ◽

Serum Calcium ◽

Hypovitaminosis D ◽

Healthy Controls ◽

Mineral Density ◽

Mineral Concentration ◽

Neck Of Femur ◽

Vitamin D Levels

Chronic hemoglobinopathies like thalassemia are associated with many osteopathies like osteoporosis.Methods. This observational study was carried out to compare the bone mineral density (BMD) in transfusion dependent thalassemics with that of healthy controls. Thirty-two thalassemia patients, aged 2–18 years, and 32 age and sex matched controls were studied. The bone mineral concentration (BMC) and BMD were assessed at lumbar spine, distal radius, and neck of femur. Biochemical parameters like serum calcium and vitamin D levels were also assessed.Results. The BMC of neck of femur was significantly low in cases in comparison to controls. We also observed significantly lower BMD at the lumbar spine in cases in comparison to controls. A significantly positive correlation was observed between serum calcium levels and BMD at neck of femur.Conclusion. Hence, low serum calcium may be used as a predictor of low BMD especially in populations where incidence of hypovitaminosis D is very high.

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Screening of bone mineral density by densitometer and correlation with serum calcium and vitamin D levels to detect early osteoporotic changes in postmenopausal women in slum areas of Raipur and Kalupur of Ahmedabad

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20150874 ◽

2015 ◽

pp. 960-965 ◽

Cited By ~ 4

Author(s):

Adarshjit Singh ◽

Harpreet Singh ◽

Safal Patel

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Postmenopausal Women ◽

Bone Mineral ◽

Serum Calcium ◽

Mineral Density ◽

Vitamin D Levels ◽

Slum Areas

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Assessment of Bone Metabolism and Bone Mineral Density in Children with Helicobacter pylori Infection

Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy ◽

10.5222/bmj.2020.35229 ◽

2020 ◽

Author(s):

Nafiye Urgancı ◽

Derya Kalyoncu

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Helicobacter Pylori ◽

Bone Metabolism ◽

Bone Mineral ◽

Biochemical Parameters ◽

Mineral Density ◽

Vitamin D Levels ◽

Significant Difference ◽

H Pylori

Objective: Gastrointestinal disorders may have negative impact on bone metabolism. The aim of the study was to evaluate bone metabolism and bone mineral density in children with Helicobacter pylori (H. pylori) infection. Method: A total of 100 children (mean age: 13.69±2.44 years, M/F: 0.66) with chronic gastritis were divided into two groups according to presence of H. pylori infection and were tested for biochemical parameters such as calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone and vitamin D. Bone mineral density was measured at lumbar spine in all of the patients by dual-energy x-ray absorptiometry (DXA). Results: 48 of 72 patients with H. pylori and 16 of 28 patients without H. pylori had low vitamin D levels (p=0.35). The other biochemical parameters were within normal limits in both groups. Bone mineral density was measured -0.16±2.25 g/cm2 in H. pylori-positive patients and -0.08±2.62 g/cm2 in H. pylori-negative patients (p=0.87). Only 2 patients with H. pylori and 1 without H. pylori had BMD z scores below -2.5 (p=1.00). Conclusion: No significant difference was observed in biochemical parameters of bone metabolism and bone mineral density between H.pylori-positive and H. pylori-negative children.

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Management of bone metabolism in epilepsy

Ideggyógyászati Szemle ◽

10.18071/isz.74.0257 ◽

2021 ◽

Vol 74 (7-8) ◽

pp. 257-265

Author(s):

Firdevs Ezgi Uçan Tokuç ◽

Fatma Genç ◽

Abidin Erdal ◽

Yasemin Biçer Gömceli

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Bone Metabolism ◽

Bone Mineral ◽

Outpatient Clinic ◽

Bone Mineralization ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Increased Risk ◽

Significant Difference

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

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