Low Parathyroid Hormone Levels in Bedridden Geriatric Patients with Vitamin D Deficiency

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Abstract

OBJECTIVES:

To identify the clinical conditions associated with low parathyroid hormone (PTH) in patients with vitamin D deficiency and to evaluate the stability of the blunted PTH response to vitamin D deficiency over 6 months.

DESIGN:

Secondary analysis of a randomized double-blind controlled vitamin D supplementation trial.

SETTING:

Four long-term care hospitals in Helsinki, Finland.

PARTICIPANTS:

Two hundred eighteen chronically bedridden patients.

MEASUREMENTS:

Plasma 25-hydroxyvitamin D (25-OHD), intact PTH, amino-terminal propeptide of type I procollagen (PINP), carboxy-terminal telopeptide of type I collagen (ICTP), activities of daily living (ADLs), and body mass index (BMI) were measured at baseline and at 6 months. Patient records were reviewed for demographic data.

RESULTS:

PTH was within reference values (8-73 ng/L) despite low 25-OHD level (<50 nmol/L) in 74.8% (n=163) of patients (mean age 84.5±7.5). Patients in the lowest PTH quartile (<38 ng/L) were characterized by a history of hip fractures (OR=2.9, P=0.01), low BMI (OR=0.9, P=.02), and high ICTP (OR=1.1, P=.03). PTH remained within reference values even after 6 months in 76.2% of the patients with persistent vitamin D deficiency in the placebo group.

CONCLUSION:

The absence of secondary hyperparathyroidism seems to be common and persistent in frail chronically bedridden patients with vitamin D deficiency. Attenuated parathyroid function appears to be associated with immobilization that causes accelerated bone resorption. Further studies addressing the possible adverse effects of low PTH are warranted.

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