Osteoporosis International

, Volume 17, Issue 7, pp 1013–1021 | Cite as

Vitamin D insufficiency and the blunted PTH response in established osteoporosis: the role of magnesium deficiency

  • O. Sahota
  • M. K. Mundey
  • P. San
  • I. M. Godber
  • D. J. Hosking
Original Article

Abstract

Introduction

Vitamin D insufficiency is common, however within individuals, not all manifest the biochemical effects of PTH excess. This further extends to patients with established osteoporosis. The mechanism underlying the blunted PTH response is unclear but may be related to magnesium (Mg) deficiency. The aims of this study were to compare in patients with established osteoporosis and differing degrees of vitamin D and PTH status : (1) the presence of Mg deficiency using the standard Mg loading test (2) evaluate the effects of Mg loading on the calcium-PTH endocrine axis (3) determine the effects of oral, short term Mg supplementation on the calcium-PTH endocrine axis and bone turnover.

Methods

30 patients (10 women in 3 groups) were evaluated prospectively measuring calcium, PTH, Mg retention (Mg loading test), dietary nutrient intake (calcium, vitamin D, Mg) and bone turnover markers (serum CTX & P1CP). Multivariate analysis controlling for potential confounding baseline variable was undertaken for the measured outcomes.

Results

All subjects, within the low vitamin D and low PTH group following the magnesium loading test had evidence of Mg depletion [mean(SD) retention 70.3%(12.5)] and showed an increase in calcium 0.06(0.01) mmol/l [95% CI 0.03, 0.09, p=0.007], together with a rise in PTH 13.3 ng/l (4.5) [95% CI 3.2, 23.4, p=0.016] compared to baseline. Following oral supplementation bone turnover increased: CTX 0.16 (0.06) mcg/l [95%CI 0.01, 0.32 p=0.047]; P1CP 13.1 (5.7) mcg/l [95% CI 0.29, 26.6 p=0.049]. In subjects with a low vitamin D and raised PTH mean retention was 55.9%(14.8) and in the vitamin replete group 36.1%(14.4), with little change in both acute markers of calcium homeostasis and bone turnover markers following both the loading test and oral supplementation.

Conclusions

This study confirms that in patients with established osteoporosis, there is also a distinct group with a low vitamin D and a blunted PTH level and that Mg deficiency (as measured by the Mg loading test) is an important contributing factor.

Keywords

Functional hypoparathyroidism Magnesium Osteoporosis Secondary hyperparathyroidism Vitamin D 

Notes

Acknowledgements

The authors are grateful to the research nurses in the Metabolic Unit for their help in collating data. We are also grateful to Isabel Fowler in the Department of Clinical Chemistry for her support in preparing/analysing some of the biochemical samples, and Vincent Crosby for his advice on undertaking the Mg studies.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • O. Sahota
    • 1
  • M. K. Mundey
    • 2
  • P. San
    • 3
  • I. M. Godber
    • 4
  • D. J. Hosking
    • 3
  1. 1.Department of Health Care of the ElderlyQueens Medical Centre, University HospitalNottinghamUK
  2. 2.School of Biomedical SciencesQueens Medical Centre, University HospitalNottinghamUK
  3. 3.Division of Mineral MetabolismCity HospitalNottinghamUK
  4. 4.Clinical LaboratoriesWishaw General HospitalWishawUK

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