title: Hypovitaminosis D and hyperparathyroidism: effects on bone turnover and bone mineral density among perinatally HIV-infected adolescents.
abstract: OBJECTIVE
  The impact of hypovitaminosis D and secondary hyperparathyroidism on bone mineral density (BMD) in the setting of pediatric HIV infection remains unclear. This study aimed to determine the prevalence of hypovitaminosis D and hyperparathyroidism and their effects on bone turnover and BMD among HIV-infected adolescents in Southeast Asia.
  
  
  METHODS
  A multicenter, cross-sectional study evaluating bone health and vitamin D metabolism in HIV-infected adolescents in Thailand and Indonesia.
  
  
  METHODS
  Perinatally HIV-infected adolescents aged 10-18 years on antiretroviral therapy with virologic suppression were enrolled. Serum 25-hydroxyvitamin D, intact parathyroid hormone, and bone turnover markers (C-terminal cross-linked telopeptide of type I collagen and procollagen type I amino-terminal propeptide) were assessed; serum 25-hydroxyvitamin D less than 20 ng/ml and intact parathyroid hormone more than 65 pg/ml were defined as hypovitaminosis D and hyperparathyroidism, respectively. Lumbar spine (L2-L4) BMD Z-score -2 or less was defined as low BMD.
  
  
  RESULTS
  Of 394 adolescents, 57% were women. The median age [interquartile range (IQR)] was 15.0 (13.3-16.9) years. The prevalence of hypovitaminosis D, hyperparathyroidism, and both conditions were 21% [95% confidence interval (CI): 17-25%], 17% (95% CI: 13-20%), and 5% (95% CI: 3-7%), respectively. Adolescents with hypovitaminosis D and secondary hyperparathyroidism had the highest median bone resorption (C-terminal cross-linked telopeptide of type I collagen: 1610 vs. 1270 ng/l; P = 0.04) and bone formation (procollagen type I amino-terminal propeptide: 572 vs. 330 μg/l; P = 0.02) markers, and the greatest proportion of low BMD (42 vs. 15%; P = 0.01) compared with the rest of the cohort.
  
  
  CONCLUSIONS
  Hypovitaminosis D complicated with secondary hyperparathyroidism was associated with increased bone turnover and bone loss. Early treatment of hypovitaminosis D before hyperparathyroidism occurs may be important to prevent bone mass deterioration.
authors.affiliation: aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA bDepartment of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai cHIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok dResearch Institute for Health Sciences, Chiang Mai University, Chiang Mai eSrinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand fDepartment of Child Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia gThe Henry M. Jackson Foundation for the Advancement of Military Medicine, the US Military HIV Research Program, Bethesda, Maryland, USA hDepartment of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Linda
authors.initials: L
authors.lastname: Aurpibul
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.forename: Wasana
authors.initials: W
authors.lastname: Prasitsuebsai
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Sophonphan
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
mesh_terms: D000293:Adolescent; D015519:Bone Density; D016723:Bone Remodeling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology*; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology*; D013785:Thailand / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000150:complications*