Osteoporosis International

, Volume 25, Issue 7, pp 1931–1936

Variations in parathyroid hormone concentration in patients with low 25 hydroxyvitamin D

Original Article

DOI: 10.1007/s00198-014-2687-4

Cite this article as:
Shibli-Rahhal, A. & Paturi, B. Osteoporos Int (2014) 25: 1931. doi:10.1007/s00198-014-2687-4



Although 25 hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels are inversely related, less than half of the patients with a low vitamin D level have an elevated PTH, and, in most of these patients, the PTH does not immediately normalize with correction of the vitamin D.


Despite the inverse relationship between 25OHD and PTH, patients with vitamin D deficiency seen in clinical practice do not always have an elevated PTH, and, in those with secondary hyperparathyroidism, the PTH does not always normalize with correction of vitamin D deficiency. We examined variations in PTH concentrations in patients with low 25OHD and studied changes in the PTH concentration with restoration of vitamin D sufficiency.


This was a retrospective cohort study of patients with a 25OHD < 30 ng/mL and a concomitant PTH measurement seen at the Metabolic Bone Disease Clinic at a tertiary care center between July 1, 2007 and May 31, 2011. Patients with conditions associated with alterations in PTH were excluded.


The study population consisted of 104 patients. The mean age was 55.5 years, and 83 % were female. The 25OHD and PTH were negatively correlated, but only 30 % of patients with a 25OHD < 30 ng/mL and 40 % of those with a 25OHD < 20 ng/mL had an elevated PTH. As the 25OHD increased to 30 ng/mL or higher, the PTH decreased significantly in the group of patients who had an elevated PTH at baseline, but only 44 % reached a normal PTH. Of patients with a normal PTH at baseline, 59 % experienced a drop in their PTH while the PTH remained unchanged or increased in 41 %.


PTH has a limited role in defining vitamin D status in individual patients and in guiding vitamin D therapy in clinical practice.


Hyperparathyroidism PTH Vitamin D 



25 Hydroxyvitamin D


Amal Shibli-Rahhal


Bhanu Paturi


Electronic medical record


Parathyroid hormone


Statistical analysis system

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  1. 1.Division of Endocrinology, Diabetes, and Metabolism, Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA
  2. 2.Division of Endocrinology, Diabetes, and Metabolism, Department of Internal MedicineSaint Francis Medical CenterPeoriaUSA
  3. 3.Joslin Diabetes CenterPeoriaUSA
  4. 4.Division of Endocrinology, E 426 GHUniversity of Iowa Carver College of MedicineIowa CityUSA

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