[Prevalence of secondary hyperparathyroidism (SHPT) and causal factors in adult population in Reykjavík area].
BACKGROUND
SHPT is a consequence of decreased concentration of ionized calcium in blood, which may have many causes. The purpose of this study was to assess the prevalence and contributing factors of SHPT in an adult Icelandic population and explore the relationship between PTH and other variables which might explain age related increase in PTH. Such knowledge might be helpful in evaluating the results of PTH measurements. METHODS AND STUDY GROUP: The study group was a random sample of men and women in the Reykjavik area, 30-85 years of age. Serum PTH was measured by ECLIA (Roche Diagnostics), serum 25(OH)D by RIA (DiaSorin), and body composition by DXA. SHPT was defined as PTH >65 ng/l and ionized calcium <1.25 mmol/l. Inadequate vitamin D was defined as serum 25(OH)D 25-45 nmol/l and vitamin D deficiency <25 nmol/l, inadequate calcium intake <800 mg/day (from questionnaire) and reduced kidney function as serum cystatin-C >1.55 ng/l. The relationship between PTH and other variables was assessed by Spearman?s correlation coefficient and linear regression.


RESULTS
Of 2,310 individuals invited 1,630 attended (70%), 586 men and 1,023 women. Further 21 were excluded because of primary hyperparathyroidism. Of the total group 6.6% did have SHPT, 7.7% of the women and 4.6% of men (p<0.01 by gender). Underlying causes were identified in 90% of cases, most commonly inadequate vitamin D (73%). Other important causes were obesity, inadequate calcium intake, reduced kidney function and furosemide intake. Many individuals did have more than one possible underlying cause. The concentration of PTH was found in a multivariate linear regression to be associated with age, ionized calcium, 25(OH)D, cystatin-C, smoking, and BMI, especially fat mass. Testosterone did have a weak negative relationship with PTH in men.


CONCLUSIONS
Most cases of SHPT could be explained by known causes and far the commonest was inadequate vitamin D. The prevalence of SHPT in Iceland is probably higher than described elsewhere, possibly due to less sunlight exposure. These results would suggest that a greater intake of vitamin D is needed in Iceland. The relationship of PTH with body composition, especially fat mass, sex hormones and smoking, needs further evaluation.
Karlsson
Snorri Laxdal
SL
Iceland University Hospital, Fossvogi, 108 Reykjavík.
Indridason
Olafur Skúli
OS
Franzson
Leifur
L
Sigurdsson
Gunnar
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D002136:Calcium, Dietary / Q000008:administration & dosage; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D007055:Iceland / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000031:analogs & derivatives* / Q000097:blood; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014808:Vitamin D Deficiency / Q000150:complications*
C525030:CST3 protein, human; D002136:Calcium, Dietary; D055316:Cystatin C; D015891:Cystatins; C470125:PTH protein, human; D010281:Parathyroid Hormone