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Relationship between vitamin D, parathyroid hormone, and bone mineral density in elderly Koreans.

Kim G, Oh KW, Jang EH, Kim MK, Lim DJ, Kwon HS, Baek KH, Yoon KH, Lee WC, Cha BY, Lee KW, Son HY, Kang MI - J. Korean Med. Sci. (2012)

Bottom Line: Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women.In winter, age-associated iPTH increase in women was steeper than in summer.Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged ≤ 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.

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Related in: MedlinePlus

Mean serum 25(OH)D and iPTH levels according to season and age in men and women. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001) and ≥ 70 yr (P = 0.018) in the winter and summer seasons, respectively. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine clearance and BMI) and ≥ 70 yr (P = 0.018; P = 0.043 after adjustment for creatinine clearance and BMI) in the winter and summer seasons, respectively. Black boxes indicate men and blank circles indicate women; Dashed lines indicate mean values adjusted for BMI and creatinine clearance; Numbers in squared brackets indicate numbers of men and numbers in round brackets indicates numbers of postmenopausal women, respectively (ANOVA, Dunnett's multiple comparison test, ANCOVA, Bonferroni's multiple comparison).
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Figure 3: Mean serum 25(OH)D and iPTH levels according to season and age in men and women. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001) and ≥ 70 yr (P = 0.018) in the winter and summer seasons, respectively. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine clearance and BMI) and ≥ 70 yr (P = 0.018; P = 0.043 after adjustment for creatinine clearance and BMI) in the winter and summer seasons, respectively. Black boxes indicate men and blank circles indicate women; Dashed lines indicate mean values adjusted for BMI and creatinine clearance; Numbers in squared brackets indicate numbers of men and numbers in round brackets indicates numbers of postmenopausal women, respectively (ANOVA, Dunnett's multiple comparison test, ANCOVA, Bonferroni's multiple comparison).

Mentions: Subjects were divided into those who had blood tests in the winter season (September-February) and the summer season (May-August), respectively. Serum 25(OH)D levels were significantly lower and serum iPTH levels significantly higher in the winter season compared with the summer season in both men (25[OH]D, 19.97 ± 7.19 vs 24.05 ± 7.04 ng/mL, P < 0.001; iPTH 52.01 ± 23.74 vs 43.85 ± 14.53 pg/mL, P < 0.001) and women (25[OH]D, 15.58 ± 5.36 vs 18.06 ± 6.44 ng/mL, P < 0.001; iPTH, 52.01 ± 23.74 vs 43.85 ± 14.53 pg/mL, P < 0.001), respectively. Men and women were further subcategorized by age (decades) in each season and mean 25(OH)D and iPTH levels were compared among decades. 25(OH)D levels were lower in women than in men in most age groups both in the winter and summer seasons. There were no differences in 25(OH)D levels among different age groups in both men and women in the winter season. However, in the summer season, there was a significant progressive decrease in 25(OH)D levels with age in men but no significant difference in women. iPTH levels were significantly higher in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine and BMI) and ≥ 70 yr (P = 0.018; P = 0.047 after adjustment for creatinine and BMI) in the winter and summer seasons, respectively (ANOVA, Dunnett's multiple comparison test; ANCOVA, Bonferroni's multiple comparison). On the contrary, there were no differences in iPTH levels among across decades in men both in the winter and the summer seasons (Fig. 3).


Relationship between vitamin D, parathyroid hormone, and bone mineral density in elderly Koreans.

Kim G, Oh KW, Jang EH, Kim MK, Lim DJ, Kwon HS, Baek KH, Yoon KH, Lee WC, Cha BY, Lee KW, Son HY, Kang MI - J. Korean Med. Sci. (2012)

Mean serum 25(OH)D and iPTH levels according to season and age in men and women. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001) and ≥ 70 yr (P = 0.018) in the winter and summer seasons, respectively. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine clearance and BMI) and ≥ 70 yr (P = 0.018; P = 0.043 after adjustment for creatinine clearance and BMI) in the winter and summer seasons, respectively. Black boxes indicate men and blank circles indicate women; Dashed lines indicate mean values adjusted for BMI and creatinine clearance; Numbers in squared brackets indicate numbers of men and numbers in round brackets indicates numbers of postmenopausal women, respectively (ANOVA, Dunnett's multiple comparison test, ANCOVA, Bonferroni's multiple comparison).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369450&req=5

Figure 3: Mean serum 25(OH)D and iPTH levels according to season and age in men and women. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001) and ≥ 70 yr (P = 0.018) in the winter and summer seasons, respectively. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine clearance and BMI) and ≥ 70 yr (P = 0.018; P = 0.043 after adjustment for creatinine clearance and BMI) in the winter and summer seasons, respectively. Black boxes indicate men and blank circles indicate women; Dashed lines indicate mean values adjusted for BMI and creatinine clearance; Numbers in squared brackets indicate numbers of men and numbers in round brackets indicates numbers of postmenopausal women, respectively (ANOVA, Dunnett's multiple comparison test, ANCOVA, Bonferroni's multiple comparison).
Mentions: Subjects were divided into those who had blood tests in the winter season (September-February) and the summer season (May-August), respectively. Serum 25(OH)D levels were significantly lower and serum iPTH levels significantly higher in the winter season compared with the summer season in both men (25[OH]D, 19.97 ± 7.19 vs 24.05 ± 7.04 ng/mL, P < 0.001; iPTH 52.01 ± 23.74 vs 43.85 ± 14.53 pg/mL, P < 0.001) and women (25[OH]D, 15.58 ± 5.36 vs 18.06 ± 6.44 ng/mL, P < 0.001; iPTH, 52.01 ± 23.74 vs 43.85 ± 14.53 pg/mL, P < 0.001), respectively. Men and women were further subcategorized by age (decades) in each season and mean 25(OH)D and iPTH levels were compared among decades. 25(OH)D levels were lower in women than in men in most age groups both in the winter and summer seasons. There were no differences in 25(OH)D levels among different age groups in both men and women in the winter season. However, in the summer season, there was a significant progressive decrease in 25(OH)D levels with age in men but no significant difference in women. iPTH levels were significantly higher in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine and BMI) and ≥ 70 yr (P = 0.018; P = 0.047 after adjustment for creatinine and BMI) in the winter and summer seasons, respectively (ANOVA, Dunnett's multiple comparison test; ANCOVA, Bonferroni's multiple comparison). On the contrary, there were no differences in iPTH levels among across decades in men both in the winter and the summer seasons (Fig. 3).

Bottom Line: Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women.In winter, age-associated iPTH increase in women was steeper than in summer.Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged ≤ 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.

Show MeSH
Related in: MedlinePlus