Skip to main content

Advertisement

Log in

Bone metabolism, density, and geometry in postmenopausal women with vitamin D insufficiency: a cross-sectional comparison of the effects of elevated parathyroid levels

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Increased levels of parathyroid hormone (PTH) may have adverse effects on bone health. In a cross-sectional design, we investigated this hypothesis among 102 postmenopausal vitamin D insufficient women. Elevated PTH was associated with altered bone geometry, decreased bone mineral density in the spine, and increased bone turnover.

Introduction

In vitamin D insufficiency, elevated parathyroid hormone (PTH) levels may contribute to adverse effect on bone. We assessed effects of PTH responses to vitamin D insufficiency on bone metabolism, density, and geometry.

Methods

Using a cross-sectional design, we investigated 102 healthy postmenopausal women with low 25-hydroxy-vitamin D (< 50 nmol/L) levels, who had either secondary hyperparathyroidism with elevated PTH levels (> 6.9 pmol/L, N = 51) or normal PTH levels (N = 51). Bone mineral density (BMD) and bone geometry were assessed by Dual-Energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT) and high-resolution peripheral QCT (HRpQCT) scans. Bone metabolism was assessed by biochemistry including bone turnover markers.

Results

Levels of 25(OH)D were 38 (IQR 31–45) nmol/L with no differences between groups. PTH levels were 8.5 (IQR 7.5–9.5) in women with SHPT and 5.2 (4.4–6.6) pmol/L in women with normal PTH (p < 0.001). BMI and eGFR did not differ between groups. SHPT was associated with lower total- and trabecular bone area, lower cortical perimeter, and increased cortical area in tibia and radius. SHPT was associated with a lower weight-adjusted BMD at the lumbar spine (p < 0.05). High compared to normal PTH levels were associated with significantly lower plasma levels of 1,25(OH)2D, phosphate, but higher levels of osteocalcin and borderline higher levels of CTx. PTH correlated to osteocalcin and CTx.

Conclusions

High PTH levels are associated with altered bone geometry, increased bone turnover, and reduced BMD at the spine. Whether an increased cortical thickness with a lower trabecular volume is an effect of PTH or not needs further elucidations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Barone A, Giusti A, Pioli G, Girasole G, Razzano M, Pizzonia M, Palummeri E, Bianchi G (2007) Secondary hyperparathyroidism due to hypovitaminosis D affects bone mineral density response to alendronate in elderly women with osteoporosis: a randomized controlled trial. J Am Geriatr Soc 55:752–757. https://doi.org/10.1111/j.1532-5415.2007.01161.x

    Article  PubMed  Google Scholar 

  2. MacDonald HM, Wood AD, Aucott LS et al (2013) Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1-year double-blind RCT in postmenopausal women. J Bone Miner Res 28:2202–2213. https://doi.org/10.1002/jbmr.1959

    Article  CAS  PubMed  Google Scholar 

  3. Rolighed L, Vestergaard P, Heickendorff L, Sikjaer T, Rejnmark L, Mosekilde L, Christiansen P (2013) BMD improvements after operation for primary hyperparathyroidism. Langenbeck’s Arch Surg 398:113–120. https://doi.org/10.1007/s00423-012-1026-5

    Article  Google Scholar 

  4. Sankaran S, Gamble G, Bolland M, Reid IR, Grey A (2010) Skeletal effects of interventions in mild primary hyperparathyroidism: a meta-analysis. J Clin Endocrinol Metab 95:1653–1662. https://doi.org/10.1210/jc.2009-2384

    Article  CAS  PubMed  Google Scholar 

  5. Steiniche T, Christiansen P, Vesterby A, Ullerup R, Hessov I, Mosekilde LE, Melsen F (2000) Primary hyperparathyroidism: bone structure, balance, and remodeling before and 3 years after surgical treatment. Bone 26:535–543. https://doi.org/10.1016/S8756-3282(00)00260-X

    Article  CAS  PubMed  Google Scholar 

  6. Rejnmark L, Vestergaard P, Brot C, Mosekilde L (2008) Parathyroid response to vitamin D insufficiency: relations to bone, body composition and to lifestyle characteristics. Clin Endocrinol 69:29–35. https://doi.org/10.1111/j.1365-2265.2008.03186.x

    Article  CAS  Google Scholar 

  7. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ (2004) The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35:312–319. https://doi.org/10.1016/j.bone.2004.02.003

    Article  CAS  PubMed  Google Scholar 

  8. Kannan S, Mahadevan S, Velayutham P et al (2014) Estimation of magnesium in patients with functional hypoparathyroidism. Indian J Endocrinol Metab 18:821–825. https://doi.org/10.4103/2230-8210.141365

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rejnmark L, Vestergaard P, Brot C, Mosekilde L (2011) Increased fracture risk in normocalcemic postmenopausal women with high parathyroid hormone levels: a 16-year follow-up study. Calcif Tissue Int 88:238–245. https://doi.org/10.1007/s00223-010-9454-0

    Article  CAS  PubMed  Google Scholar 

  10. Reid IR, Bolland MJ, Grey A (2014) Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 383:146–155. https://doi.org/10.1016/S0140-6736(13)61647-5

    Article  CAS  PubMed  Google Scholar 

  11. Hermann AP, Thomsen J, Vestergaard P, Mosekilde LCP (1999) Assessment of calcium intake. A quick method comparerd to a 7 days food diary. Calcif Tissue Int 82

  12. Lomholt S, Amstrup AK, Moser E, Jakobsen NFB, Mosekilde L, Vestergaard P, Rejnmark L (2015) Unexplained high BMD in DXA-scanned patients is generalized throughout the skeleton and characterized by thicker cortical and trabecular bone. Calcif Tissue Int 96:284–294. https://doi.org/10.1007/s00223-015-9955-y

    Article  CAS  PubMed  Google Scholar 

  13. Fuller H, Fuller R, Pereira RMR (2015) High resolution peripheral quantitative computed tomography for the assessment of morphological and mechanical bone parameters. Rev Bras Reumatol (English Ed) 55:352–362. https://doi.org/10.1016/j.rbre.2014.07.010

    Article  Google Scholar 

  14. Pistoia W, van Rietbergen B, E-MM L et al (2002) Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone 30:842–848. https://doi.org/10.1016/S8756-3282(02)00736-6

    Article  CAS  PubMed  Google Scholar 

  15. Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV, Lindsay R, Clemens TL, Bilezikian JP (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 4:283–291. https://doi.org/10.1002/jbmr.5650040302

    Article  CAS  PubMed  Google Scholar 

  16. Lindsay R, Zhou H, Cosman F, Nieves J, Dempster DW, Hodsman AB (2007) Effects of a one-month treatment with PTH(1-34) on bone formation on cancellous, endocortical, and periosteal surfaces of the human ilium. J Bone Miner Res 22:495–502. https://doi.org/10.1359/jbmr.070104

    Article  CAS  PubMed  Google Scholar 

  17. Lindsay R, Cosman F, Zhou H, Bostrom MP, Shen VW, Cruz JAD, Nieves JW, Dempster DW (2006) A novel tetracycline labeling schedule for longitudinal evaluation of the short-term effects of anabolic therapy with a single iliac crest bone biopsy: early actions of teriparatide. J Bone Miner Res 21:366–373. https://doi.org/10.1359/JBMR.051109

    Article  CAS  PubMed  Google Scholar 

  18. Jilka RL, Weinstein RS, Bellido T, Roberson P, Parfitt AM, Manolagas SC (1999) Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest 104:439–446. https://doi.org/10.1172/JCI6610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hernandez JL, Olmos JM, Pariente E et al (2013) Influence of vitamin D status on vertebral fractures, bone mineral density, and bone turnover markers in normocalcemic postmenopausal women with high parathyroid hormone levels. J Clin Endocrinol Metab 98:1711–1717. https://doi.org/10.1210/jc.2012-3931

    Article  CAS  PubMed  Google Scholar 

  20. Blaine J, Chonchol M, Levi M (2015) Renal control of calcium, phosphate, and Magnesium 10:1257–1272. https://doi.org/10.2215/CJN.09750913

  21. Sahota O, Gaynor K, Harwood RH, Hosking DJ (2001) Hypovitaminosis D and “functional hypoparathyroidism”—the NoNoF (nottingham neck of femur) study. Age Ageing 30:467–472. https://doi.org/10.1093/ageing/30.6.467

    Article  CAS  PubMed  Google Scholar 

  22. Sahota O, Mundey MK, San P, Godber IM, Hosking DJ (2006) Vitamin D insufficiency and the blunted PTH response in established osteoporosis: the role of magnesium deficiency. Osteoporos Int 17:1013–1021. https://doi.org/10.1007/s00198-006-0084-3

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L.L. Rødbro.

Ethics declarations

The study was conducted in accordance with the Helsinki II declaration considering biomedical research regarding humans. Informed, written consent was obtained from all participants. The Danish Data Protection Agency (1-16-02-492-14), the Regional Committee on Biomedical Research Ethics (1-10-72-326-14), the Danish Health Authority (2014-003645-10), and Danish Health Data Authority (FSEID-00001274) approved the project.

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rødbro, L., Bislev, L., Sikjær, T. et al. Bone metabolism, density, and geometry in postmenopausal women with vitamin D insufficiency: a cross-sectional comparison of the effects of elevated parathyroid levels. Osteoporos Int 29, 2211–2218 (2018). https://doi.org/10.1007/s00198-018-4602-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-018-4602-x

Keywords

Navigation