Comparison of the Effect of Secondary Hyperparathyroidism Due to Vitamin D Deficiency on Bone with the Healthy Control Group

Öz

Aim: In healthy individuals, to demonstrate that adequate vitamin D status protects against osteoporosis by improving bone mineral density and reducing the risk of fractures. Material and method: Fifty patients with high parathyroid hormone secondary to low vitamin D level and 50 patients with normal parathyroid hormones were included in the study as the control group. Results: Of the 50 patients with secondary hyperparathyroidism due to vitamin D deficiency included in the study, 45 (90%) were female and 5 (10%) were male. In the control group with normal parathyroid hormone, 44 (88%) were female and 6% (12%) were male. The median age in the hyperparathyroid group was 70.5 (66-73) and in the parathyroid hormone normal group it was 71 (69-73). This median mean age was significant (p 0.004). In the group with secondary hyperparathyroidism; The median PTH value was 99.5 (66-205.9) and 49.8 (27-61.5) in the control group, with a significant difference (p < 0.001). While 25-Hydroxy Vitamin D level was 10.73 (4.64-34.1) in the group with normal parathyroid hormone level, it was 18.63 (6.21-65.1). This created a significant difference in both groups (p < 0.001). According to the results of bone densitometry in the hyperparathyroidic and control groups. no significant difference was found between bone mineral density (BMD). 0.92 (0.66 – 1134), 0.93 (0.75 – 1293), (p0.095). However, for the femur, the results in T and Z scores were significant (p 0.027- p 0.027), whereas for the supine (spine), no significant difference was observed between the T and Z scores (p 0.358- p 0.265). Conclusion: . Especially when the vitamin D level falls below 10 ng/mL, PTH begins to respond. Beyond these observations, a normal serum 25(OH)D concentration is particularly important in preventing femur fractures, but its significance for vertebral fractures is unclear.

Anahtar Kelimeler

• Vitamin D
• secondary hyperparathyroidism
• osteoporosis

D Vitamini Eksikliğine Bağlı Sekonder Hiperparatiroidizm’in Kemik Üzerine Etkisinin Sağlıklı Kontrol Grubu ile Karşılaştırılması

Öz

Giriş: Sağlıklı bireylerde yeterli D vitamini durumunun, kemik mineral yoğunluğunu iyileştirerek ve kırık riskini azaltarak, osteoporoza karşı koruduğunu göstermektir. Gereç ve Yöntem :D vitamin seviyesi düşüklüğüne sekonder, paratiroid hormonu yüksek 50 hasta ile paratiroid hormonları normal olan, 50 hasta kontrol grubu olarak çalışmaya dahil edildi. Bulgular: Çalışmaya dahil edilen D vitamin eksikliğine bağlı sekonder hiperparatiroidizm’li 50 hastanın,45’i (90%) kadın, 5’i(10%) erkekti. Paratiroid hormonu normal olan kontrol grubunda ise, 44’ü(88%) kadın,6’sı(12%) erkekti Hiperparatiroidik grupta median yaş ortalaması 70.5(66-73), paratiroid hormonu normal grupta ise 71(69-73) idi. Bu median yaş ortalaması anlamlıydı (p 0.004). Sekonder hiperparatirodizmli grupta; PTH median değeri 99.5 (66-205.9),kontrol grubunda ise 49.8 (27-61.5) olup anlamlı fark gözlendi(p < 0.001). 25-Hydroxy Vitamin D seviyesi 10.73 (4.64-34.1)iken, paratiroid hormon seviyesi normal olan grupta 18.63 (6.21-65.1) idi. Bu da her iki grupta anlamlı fark oluşturdu(p < 0.001). Hiperparatiroidik ve kontrol grubunda çekilen kemik dansitometresi sonuçlarına göre. kemik mineral yoğunluğu(BMD) arasında anlamlı fark saptanmadı. 0.92 (0.66 – 1134), 0.93 (0.75 – 1293),(p0.095). Buna rağmen femur için, T ve Z scorlarındaki sonuç anlamlı iken (p 0.027- p 0.027),supin(omurga),için T ve Z scorları arasında anlamlı fark gözlenmedi( p 0.358- p 0.265). Sonuç: . Özellikle D vitamin seviyesi 10 ng/mL’nin altına indiğinde PTH cevap vermeye başlamaktadır. Bu gözlemlerin ötesinde, serum 25(OH)D konsantrasyonunun normal seviyede olması özellikle femur kırıklarından korumada önemli iken, vertebra kırıkları için önemi belirsizdir.

Anahtar Kelimeler

• D vitamini
• sekonder hiperparatiroidizm
• osteoporoz

Kaynakça

1. 1. Morris HA, O'Loughlin PD, Anderson PH. Experimental evidence for the effects of calcium and vitamin D on bone: a review. Nutrients. 2010;2(9):1026-35.
2. 2. Turner AG, Anderson PH, Morris HA. Vitamin D and bone health. Scand J Clin Lab Invest Suppl. 2012;243:65-72.
3. 3. Reid IR. Vitamin D Effect on Bone Mineral Density and Fractures. Endocrinol Metab Clin North Am. 2017;46(4):935-945.
4. 4. Muppidi V, Meegada SR, Rehman A. Secondary Hyperparathyroidism. 2023 Feb 12. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023;1:1.
5. 5. Yalla N, Bobba G, Guo G, et. al. Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status. J Endocrinol Invest. 2019;42(11):1353-1360.
6. 6. Vieth R.Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. a. Am J Clin Nutr. 1999;69: 842-856.
7. 7. Van der Wielen R.P, Lowik M.R. Van den Berg H., et al. Serum vitamin D concentrations among elderly people in Europe. Lancet. 1995;346:207-210.
8. 8. McKenna M.J. Freaney R.Secondary hyperparathyroidism in the elderly: Means to defining hypovitaminosis D. Osteoporos Int. 1998;8:3-6.

9. 9. Gómez-Alonso C, Naves-Díaz ML, Fernández-Martín JL, et. al. Vitamin D status and secondary hyperparathyroidism: the importance of 25-hydroxyvitamin D cut-off levels. Kidney Int Suppl. 2003;(85):S44-8.
10. 10. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2014;383(9912):146-55.
11. 11. Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018;6(11):847-858.
12. 12. Macdonald HM, Reid IR, Gamble GD, et. Al. 25-Hydroxyvitamin D Threshold for the Effects of Vitamin D Supplements on Bone Density: Secondary Analysis of a Randomized Controlled Trial. J Bone Miner Res. 2018;33(8):1464-1469.
13. 13. Reid IR, Horne AM, Mihov B, et. Al. Effect of monthly high-dose vitamin D on bone density in community-dwelling older adults substudy of a randomized controlled trial. J Intern Med. 2017;282(5):452-460.
14. 14. Zhao JG, Zeng XT, Wang J, et. al. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017;318(24):2466-2482.
15. 15. Kanno A, Aizawa T, Mori Y, et. al. Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone. J Orthop Sci. 2022;2658(22):315-118.
16. 16. Reid IR, Bolland MJ. Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It? Nutrients. 2020;12(4):1011.
17. 17. Beaudart C, Buckinx F, Rabenda V, et. al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014;99(11):4336-45.
18. 18. Sayed-Hassan R, Abazid N, Koudsi A, et. al. Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults. Arch Osteoporos. 2016;11:18.