Bone mineral density increases with vitamin D repletion in patients with coexistent vitamin D insufficiency and primary hyperparathyroidism.
Two hundred and twenty-nine consecutive subjects, 202 women and 27 men, referred for evaluation of osteoporosis or low bone mineral density (BMD) had serum measurements of immunoreactive PTH (iPTH) and 25-hydroxyvitamin D (25OHD) performed. Fifteen individuals (mean age +/- SE, 75+/-2.4 yr) had depressed serum 25OHD (<15 pg/mL) and concomitantly elevated (>65 pg/mL) iPTH levels. After successful treatment of vitamin D insufficiency in all subjects, iPTH remained inappropriately high or frankly elevated in 5, describing a 2.2% prevalence rate of coexistent primary hyperparathyroidism and vitamin D insufficiency in our population. Despite persistent primary hyperparathyroidism, normalization of serum 25OHD levels in these 5 subjects increased their BMD at an annual rate of 6.3% and 8.2% in spine and hip, respectively. Our results suggest that coexistent vitamin D insufficiency can obscure the diagnosis of primary hyperparathyroidism and, when treated effectively, can result in substantial short-terms gains in BMD despite persistence of the inappropriate production of PTH.
Kantorovich
V
V
Burns and Allen Research Institute and Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, University of California School of Medicine, Los Angeles 90048, USA.
Gacad
M A
MA
Seeger
L L
LL
Adams
J S
JS
D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D002112:Calcifediol / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood / Q000172:deficiency; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy*
D010281:Parathyroid Hormone; D014807:Vitamin D; D002112:Calcifediol