Influence of Serum Biochemistry on Bone and Kidney Phenotypes in Subjects With Symptomatic Primary Hyperparathyroidism

Abstract OBJECTIVETo analyze the abnormalities in serum parathormone (PTH)-25-hydroxy-vitamin D (25-OHD) axis and calcium phosphate homeostasis in symptomatic PHPT patients having bone disease, nephrolithiasis and impaired renal function (IRF) at diagnosis. METHODSConsecutive adults (>18 years) with diagnosed symptomatic PHPT were enrolled in the retrospective study. Relevant clinical, biochemical and imaging parameters were recorded.RESULTSAdult patients with symptomatic PHPT were identified (N=60, age 45.2±14.4 years, 45 females). Predominant phenotypes were bone disease (osteoporosis and/or clinical fractures, n=42, 70%) and nephrolithiasis (n=24, 40%). Compared to patients with nephrolithiasis only (subgroup C, n=7) and simultaneous bone disease/nephrolithiasis (subgroup D, n=17), patients with isolated bone disease phenotype (subgroup B, n=25) had significantly higher alkaline phosphatase (AlP) and lower 25-OHD levels at presentation. Patient subgroups with nephrolithiasis had higher serum calcium levels and lower effective glomerular filtration rate (eGFR) at presentation. PTH was not significantly different among these subgroups. Patients with IRF (eGFR <60 ml/min per 1.73 m2, n=17) in our cohort had significantly higher serum calcium, phosphate, PTH levels and nephrolithiasis rates. Presence of nephrolithiasis, higher calcium x phosphate product (IRF: 36.2 ± 10.7 versus no IRF: 26.2 ± 5.7 mg2/dl2) and increased PTH levels were independently associated with IRF at diagnosis.CONCLUSIONSWhile PHPT patients with isolated bone disease were found to have lower 25-OHD and higher AlP levels independent of PTH levels; PTH was found to be an independent predictor of impaired renal function at diagnosis.

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Therapy of Hypoparathyroidism With rhPTH(1-84): A Prospective, 8-Year Investigation of Efficacy and Safety

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00893 ◽

2019 ◽

Vol 104 (11) ◽

pp. 5601-5610 ◽

Cited By ~ 7

Author(s):

Yu-Kwang Donovan Tay ◽

Gaia Tabacco ◽

Natalie E Cusano ◽

John Williams ◽

Beatriz Omeragic ◽

...

Keyword(s):

Vitamin D ◽

Renal Function ◽

Calcium Phosphate ◽

Serum Calcium ◽

Urinary Calcium ◽

Urinary Calcium Excretion ◽

Calcium Excretion ◽

Mineral Density ◽

Supplemental Calcium ◽

Phosphate Product

Abstract Context Conventional treatment of hypoparathyroidism is associated with decreased renal function and increased bone mineral density (BMD). Objective To evaluate the effects of 8 years of recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] therapy on key biochemical and densitometric indices. Design Prospective open-label trial. Setting Tertiary medical center. Participants Twenty-four subjects with hypoparathyroidism. Intervention Treatment with rhPTH(1-84) for 8 years. Main Outcome Measures Supplemental calcium and vitamin D requirements, serum calcium and phosphorus levels, calcium-phosphate product, urinary calcium excretion, estimated glomerular filtration rate (eGFR) and BMD. Results PTH therapy was associated with progressive reduction in supplemental calcium (57%; P < 0.01) and active vitamin D (76%; P < 0.001) requirements over 8 years. Serum calcium concentration was stable; urinary calcium excretion declined 38% (P < 0.01). eGFR remained stable and was related to baseline eGFR and serum calcium levels. Calcium-phosphate product was below the recommended limit; serum phosphorus remained within normal range. Lumbar spine and total hip BMD increased, peaking at 4 (mean ± SE, 4.6% ± 1.5%; P = 0.01) and 8 years (2.6% ± 1.1%; P = 0.02), whereas femoral neck BMD did not change and one-third radius BMD decreased (mean ± SE, −3.5% ± 1.1%; P = 0.001). BMD at all sites was higher throughout the 8 years than in the age- and sex-matched reference population. Hypercalcemia and hypocalcemia were uncommon. Conclusion rhPTH(1-84) is a safe and effective treatment for hypoparathyroidism for 8 years. Long-term reductions in supplemental requirements and biochemical improvements with stable renal function are maintained.

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PREVENTION OF CUTANEOUS CALCIPHYLAXIS IN CALCIUM-DEFICIENT RATS

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y65-022 ◽

1965 ◽

Vol 43 (2) ◽

pp. 235-240 ◽

Cited By ~ 2

Author(s):

Pierre Jean ◽

Denis Desaulniers

Keyword(s):

Calcium Phosphate ◽

Serum Calcium ◽

Dietary Calcium ◽

Deficient Diet ◽

Phosphate Product

Dietary calcium is essential for the production of skin calcification in rats calciphylactically sensitized with dihydrotachysterol (DHT) and challenged with FeCl3 injection, or with the mild trauma of epilation. A calcium-deficient diet delays the rise in serum calcium after the administration of DHT. A comparatively lower calcium–phosphate product at the time of challenge could explain the absence of skin calcification in these animals.

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Association of Serum Calcium and Phosphate Concentrations with Glucose Metabolism Markers: The Furukawa Nutrition and Health Study

Nutrients ◽

10.3390/nu12082344 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2344

Author(s):

Shamima Akter ◽

Masafumi Eguchi ◽

Takeshi Kochi ◽

Isamu Kabe ◽

Akiko Nanri ◽

...

Keyword(s):

Calcium Phosphate ◽

Glucose Metabolism ◽

Serum Calcium ◽

Serum Phosphate ◽

Health Study ◽

Model Assessment ◽

Adjusted Means ◽

Homeostatic Model Assessment ◽

Phosphate Product ◽

Homeostatic Model

Calcium and phosphate may play an important role in cardio-metabolic abnormalities, including type 2 diabetes; however, epidemiological evidence of the association of calcium and phosphate status with glucose metabolism among Asians is limited. In the current study, we performed a cross-sectional analysis of the association of serum calcium, phosphate, and calcium–phosphate product concentrations with glucose metabolism markers among Japanese individuals. Overall, 1701 workers (aged 18–78 years) who participated in a health survey were enrolled in this study. Multivariable linear regression models were used to estimate means of homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β), and glycated hemoglobin (HbA1c). Serum calcium concentration was positively associated with HOMA-IR and HbA1c (p for trend < 0.01). Multivariable-adjusted means (95% confidence interval (CI)) of HOMA-IR for the lowest and highest quartiles of serum calcium were 0.78 (0.75–0.82) and 1.01 (0.96–1.07), respectively. The corresponding values for HbA1c were 5.24 (5.22–5.27) and 5.29 (5.26–5.32), respectively. Serum phosphate and calcium–phosphate product concentrations were inversely associated with HOMA-IR (p for trend < 0.01). Multivariable-adjusted means (95% CI) of HOMA-IR for the lowest and highest quartiles of serum phosphate were 1.04 (0.99–1.09) and 0.72 (0.69–0.76), respectively. The corresponding values for calcium–phosphate product were 1.04 (0.99–1.09) and 0.73 (0.69–0.77), respectively. The current findings suggest that higher serum calcium and lower serum phosphate concentrations are associated with IR among apparently healthy adults.

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Elevated admission serum calcium phosphate product as an independent risk factor for acute kidney injury in hospitalized patients

Hospital Practice ◽

10.1080/21548331.2019.1568719 ◽

2019 ◽

Vol 47 (2) ◽

pp. 73-79 ◽

Cited By ~ 10

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Michael A. Mao ◽

Andrew M. Harrison ◽

Stephen B. Erickson

Keyword(s):

Acute Kidney Injury ◽

Risk Factor ◽

Calcium Phosphate ◽

Serum Calcium ◽

Independent Risk Factor ◽

Kidney Injury ◽

Hospitalized Patients ◽

Phosphate Product

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Relation between Serum Calcium, Phosphate, Parathyroid Hormone and ‘Nondipper’ Circadian Blood Pressure Variability Profile in Patients with Normal Renal Function

American Journal of Nephrology ◽

10.1159/000107489 ◽

2007 ◽

Vol 27 (5) ◽

pp. 516-521 ◽

Cited By ~ 18

Author(s):

Mehmet Kanbay ◽

Bunyamin Isik ◽

Ali Akcay ◽

Adem Ozkara ◽

Feridun Karakurt ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Parathyroid Hormone ◽

Calcium Phosphate ◽

Serum Calcium ◽

Normal Renal Function ◽

Blood Pressure Variability ◽

Circadian Blood Pressure ◽

Circadian Blood Pressure Variability

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Acute effects of calcium citrate with or without a meal, calcium-fortified juice and a dairy product meal on serum calcium and phosphate: a randomised cross-over trial

British Journal Of Nutrition ◽

10.1017/s000711451500080x ◽

2015 ◽

Vol 113 (10) ◽

pp. 1585-1594 ◽

Cited By ~ 15

Author(s):

Sarah M. Bristow ◽

Gregory D. Gamble ◽

Angela Stewart ◽

Rama Kalluru ◽

Anne M. Horne ◽

...

Keyword(s):

Single Dose ◽

Cardiovascular Risk ◽

Calcium Phosphate ◽

Serum Calcium ◽

Dairy Product ◽

Serum Phosphate ◽

Calcium Citrate ◽

Acute Effects ◽

Phosphate Product ◽

Different Sources

Ca supplements, but not dietary Ca, have been associated with increased cardiovascular risk. This difference could be related to differences in their acute effects on serum Ca. We therefore examined the effects of Ca from different sources on serum Ca and phosphate in a randomised, cross-over trial of ten women (mean age of 69 years). Fasting participants received a single dose of 500 mg of Ca as citrate, citrate with a meal, fortified juice or a dairy product meal, with at least 6 d between each intervention. Blood was sampled before and 1, 2, 4 and 6 h after each intervention was ingested. Serum ionised and total Ca increased significantly from baseline over 6 h. Using calcium citrate fasting as a comparator, the elevations in ionised and total Ca were similar after fortified juice, delayed after calcium citrate with a meal and smaller after a dairy product meal. Serum phosphate and calcium–phosphate product increased from baseline after calcium citrate with a meal and after a dairy product meal, and they declined after calcium citrate fasting and after fortified juice. The elevations in serum Ca in the present study were only slightly different from those observed after the administration of 1000 mg of Ca in a previous study. These data indicate that different sources of Ca have different acute effects on serum Ca and support recommendations that dietary Ca might be safer than supplements. Whether these differences contribute to differences in cardiovascular risk requires further study.

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