title: Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older.
abstract: The concentration or threshold of 25-hydroxyvitamin D [25(OH)D] needed to maximally suppress intact serum parathyroid hormone (iPTH) has been suggested as a measure of optimal vitamin D status. Depending upon the definition of maximal suppression of iPTH and the 2-phase regression approach used, 2 distinct clusters for a single 25(OH)D threshold have been reported: 16-20 ng/mL (40-50 nmol/L) and 30-32 ng/mL (75-80 nmol/L). To rationalize the apparently disparate published results, we compared thresholds from several regression models including a 3-phase one to estimate simultaneously 2 thresholds before and after adjusting for possible confounding for age, BMI, glomerular filtration rate, dietary calcium, and season (April-September vs. October-March) within a single data set, i.e. data from the Tufts University Sites Testing Osteoporosis Prevention/Intervention Treatment study, consisting of 181 men and 206 women (total n = 387) ages 65-87 y. Plasma 25(OH)D and serum iPTH concentrations were (mean +/- SD) 22.1 +/- 7.44 ng/mL (55.25 +/- 18.6 nmol/L) and 36.6 +/- 16.03 pg/mL (3.88 +/- 1.7 pmol/L), respectively. The 3-phase model identified 2 thresholds of 12 ng/mL (30 nmol/L) and 28 ng/mL (70 nmol/L); similar results were found from the 2-phase models evaluated, i.e. 13-20 and 27-30 ng/mL (32.5-50 and 67.5-75 nmol/L) and with previous results. Adjusting for confounding did not change the results substantially. Accordingly, the 3-phase model appears to be superior to the 2-phase approach, because it simultaneously estimates the 2 threshold clusters found from the 2-phase approaches along with estimating confidence limits. If replicated, it may be of both clinical and public health importance.
authors.affiliation: Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA.
authors.forename: Ramón A
authors.initials: RA
authors.lastname: Durazo-Arvizu
authors.forename: Bess
authors.initials: B
authors.lastname: Dawson-Hughes
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sempos
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Yetley
authors.forename: Anne C
authors.initials: AC
authors.lastname: Looker
authors.forename: Guichan
authors.initials: G
authors.lastname: Cao
authors.forename: Susan S
authors.initials: SS
authors.lastname: Harris
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Burt
authors.forename: Alicia L
authors.initials: AL
authors.lastname: Carriquiry
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Picciano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D010281:Parathyroid Hormone / Q000378:metabolism*; D012621:Seasons; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism / Q000494:pharmacology
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D