Relationships with serum parathyroid hormone in old institutionalized subjects.
OBJECTIVE
Old people in residential care are at the highest risk of any group for hip fracture. This may relate to their high prevalence of hyperparathyroidism. There are few data, however, on relationships with serum parathyroid hormone (PTH) in these individuals. This study therefore examined complex associations with serum PTH in nursing home and hostel residents.


METHODS
Cross-sectional analysis.


METHODS
One hundred and forty-three nursing home and hostel residents of median age 84 years.


METHODS
Serum PTH, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), plasma creatinine, phosphate, calcium, albumin, Bsm-1 vitamin D receptor genotype, age, weight and use of frusemide or thiazide.


RESULTS
The statistical models determined accounted for half the interindividual variation in serum PTH. Heavier weight was associated with both the prevalence of secondary hyperparathyroidism and the serum concentration of PTH. Novel interactions with serum PTH were identified between: weight and 25OHD; 25OHD and phosphate; and phosphate and thiazide diuretic use. Plasma phosphate was associated with PTH independently of calcium and 1,25-(OH)2D. There was no independent association between PTH and nuclear vitamin D receptor genotype.


CONCLUSIONS
Heavier weight is associated with both the prevalence and severity of secondary hyperparathyroidism and consistent with animal models of secondary hyperparathyroidism, phosphate may relate to serum PTH independently of 1,25-(OH)2D or calcium.
Stein
M S
MS
Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Flicker
L
L
Scherer
S C
SC
Paton
L M
LM
O'Brien
M L
ML
Walton
S C
SC
Chick
P
P
Di Carlantonio
M
M
Zajac
J D
JD
Wark
J D
JD
D000368:Aged; D000369:Aged, 80 and over; D001581:Benzothiadiazines; D001835:Body Weight; D003430:Cross-Sectional Studies; D004232:Diuretics; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005838:Genotype; D006620:Hip Fractures / Q000209:etiology; D006707:Homes for the Aged; D006801:Humans; D006887:Hydroxycholecalciferols / Q000097:blood; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000175:diagnosis*; D007326:Institutionalization; D016014:Linear Models; D008297:Male; D009735:Nursing Homes; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000097:blood; D018167:Receptors, Calcitriol / Q000235:genetics; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D001581:Benzothiadiazines; D004232:Diuretics; D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D010710:Phosphates; D018167:Receptors, Calcitriol; D049993:Sodium Chloride Symporter Inhibitors; D005665:Furosemide