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Defining vitamin D status by secondary hyperparathyroidism in the U.S. population

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Abstract

Background: Vitamin D is associated with a variety of health outcomes, but the exact definition of vitamin D sufficiency remains controversial. Aim: We sought to define skeletal-related vitamin D sufficiency by estimating maximum PTH suppression in the U.S. population. Methods: We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), 2003–2006. We examined the association between serum 25-hydroxyvitamin D (25OHD) level and serum PTH level in 14, 681 participants aged ≥6 yr. We also evaluated the 25OHD-PTH association using 2 thresholds of hyperparathyroidism: PTH≥45 pg/ml and ≥75 pg/ml. Results: The mean 25OHD level was 24 ng/ml and mean PTH was 42 pg/ml. PTH≥45 pg/ml was present in 35% of the population, while PTH≥75 pg/ml was present in 7%. The prevalence of 25OHD levels <40 ng/ml and <30 ng/ml was 95% and 77%, respectively. In both unadjusted and adjusted models, there was a strong inverse relationship between 25OHD and PTH. Compared to 25OHD≥40 ng/ml, the 25OHD-PTH association was 2.36 [95% confidence interval (CI), 2.08–2.67] times greater for 25OHD<5 ng/ml and 1.12 (95%CI, 1.07–1.17) times greater for 25OHD 30–39.9 ng/ml. Compared to 25OHD≥40 ng/ml, 25OHD levels of 20–29.9 ng/ml [odds ratio (OR) 2.0 (95%CI, 1.4–2.8)] but not 30–39.9 ng/ml [OR 1.1 (95%CI, 0.8–1.6)] were independently associated with PTH≥45 pg/ml. Conclusions: Optimal vitamin D status, defined by estimated maximum PTH suppression, does not occur until at least 25OHD levels ≥40 ng/ml. Using these thresholds, most of the U.S. population needs more vitamin D. Large, prospective studies are needed to determine optimal vitamin D supplementation.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Colorado Denver School of Medicine, 12401 E. 17th Avenue, B-215, Aurora, CO, 80045, USA

    A. A. Ginde MD, MPH

  2. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA

    P. Wolfe

  3. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    C. A. Camargo Jr

  4. Division of Geriatric Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA

    R. S. Schwartz

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  1. A. A. Ginde MD, MPH
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Correspondence to A. A. Ginde MD, MPH.

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Ginde, A.A., Wolfe, P., Camargo, C.A. et al. Defining vitamin D status by secondary hyperparathyroidism in the U.S. population. J Endocrinol Invest 35, 42–48 (2012). https://doi.org/10.3275/7742

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