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Parathyroid hormone response to two levels of vitamin D deficiency is associated with high risk of medical problems during hospitalization in patients with hip fracture

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Abstract

Background

Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fracture patients. This study was carried out to determine the factors associated with the PTH response to different levels of vitamin D deficiency during hospitalization.

Methods

This was a cross-sectional study of patients over 64 years of age admitted with an acute fragility hip fracture between March 1st 2009 and November 30th 2012. Demographic, clinical, functional, and cognitive function were evaluated at admission and during hospitalization. Levels of 25-hydroxyvitamin D (25-OHD) and PTH were analyzed. Two 25-OHD cut-off points were considered, <12 ng/ml and 12–20 ng/ml. Multivariate logistic regression analysis was used.

Results

Mean age of the 607 patients included was 84.7 years (SD 7.10), and 81.9 % were women. The mean 25-OHD level in the total sample was 13.2 (SD 11.1) ng/ml. Levels of 25-OHD <12 ng/ml were present in 347 patients (57.2 %), of whom 158 (45.5 %) had secondary hyperparathyroidism (SHPT) (PTH >65 pg/ml). 25-OHD levels of 12–20 ng/ml were present in 168 (27.7 %) patients, of whom 47 (28 %) had SHPT. Following logistic regression, SHPT was associated in both groups (25-OHD <12 and 12–20 ng/ml) with a greater number of medical problems during hospitalization. In the 25-OHD group <12 ng/ml, SHPT was also associated with poorer glomerular filtration rates.

Conclusion

The PTH response to vitamin D deficiency in hip fracture patients may be a marker for patients with higher risk of developing multiple medical problems, both when considering severe (<12 ng/ml) and moderate (12–20 ng/ml) vitamin D deficiency.

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Acknowledgements

This study was conducted in part with the support provided to emerging research groups IdiPaz-2012 of the Research Institute of the La Paz University Hospital (IdiPAZ). Project no. HULP PI-1334. The authors thank Dr. Jose Manuel Iturzaeta of the Clinical Analysis Service for assistance in processing and determining the analyses of vitamin D and PTH.

Conflict of interest

All the authors declare that they do not have conflict of interest.

Ethical approval

All procedures performed in studies involving human participants and/or animals were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Servicio de Geriatría, Hospital Universitario La Paz, IdiPaz, Paseo Castellana 261, 28046, Madrid, Spain

    T. Alarcón, J. I. González-Montalvo & R. Hoyos

  2. Servicio de Bioestadística, Hospital Universitario La Paz, IdiPaz, Madrid, Spain

    J. Diez-Sebastián

  3. Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid. IdiPaz, Madrid, Spain

    A. Otero

  4. Servicio de Traumatología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain

    J. L. Mauleon

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  1. T. Alarcón
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  2. J. I. González-Montalvo
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  3. R. Hoyos
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  4. J. Diez-Sebastián
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  5. A. Otero
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  6. J. L. Mauleon
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Correspondence to T. Alarcón.

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Alarcón, T., González-Montalvo, J.I., Hoyos, R. et al. Parathyroid hormone response to two levels of vitamin D deficiency is associated with high risk of medical problems during hospitalization in patients with hip fracture. J Endocrinol Invest 38, 1129–1135 (2015). https://doi.org/10.1007/s40618-015-0320-9

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  • DOI: https://doi.org/10.1007/s40618-015-0320-9

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