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Parathyroid hormone response to severe vitamin D deficiency is sex associated: An observational study of 571 hip fracture inpatients

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The journal of nutrition, health & aging

Abstract

Objectives

To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture.

Design

Cross-sectional study.

Setting

Rehabilitation hospital in Italy.

Participants

571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min.

Measurements

In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml).

Results

Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023).

Conclusions

Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.

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Authors and Affiliations

  1. Osteoporosis Research Center, Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy

    Marco Di Monaco, C. Castiglioni, F. Vallero & R. Tappero

  2. Department of Social Science, University, via Sant’Ottavio 50, 10124, Torino, Italy

    R. Di Monaco

Authors
  1. Marco Di Monaco
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  2. C. Castiglioni
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  3. F. Vallero
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  4. R. Di Monaco
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  5. R. Tappero
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Correspondence to Marco Di Monaco.

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Di Monaco, M., Castiglioni, C., Vallero, F. et al. Parathyroid hormone response to severe vitamin D deficiency is sex associated: An observational study of 571 hip fracture inpatients. J Nutr Health Aging 17, 180–184 (2013). https://doi.org/10.1007/s12603-012-0088-y

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  • DOI: https://doi.org/10.1007/s12603-012-0088-y

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