Despite increased BMD, prevalence of vertebral-fractures is greater in patients with IH, especially in postmenopausal women and those on anticonvulsant therapy.

Six months of cholecalciferol/calcium supplementation had no significant effect on skeletal muscle strength and serum testosterone in young adult males.

Urban Asian Indians generally have low serum 25(OH)D. Information on serum bioavailable 25(OH)D and the effect of prolonged sun-exposure in them is not known. We assessed serum 25(OH)D and bioavailable 25(OH)D in males with varying durations of sun-exposure in Delhi during August-September. Serum 25(OH)D, vitamin D-binding protein (DBP), bioavailable 25(OH)D, free 25(OH)D index, iPTH, ionized calcium and sun-index were assessed in outdoor, mixed outdoor-indoor and indoor workers (n = 88, 32 and 74, respectively). The mean sun-index (12.0 ± 6.25, 4.3 ± 2.20 and 0.7 ± 0.62, respectively; P < 0.001) was highest outdoors and lowest indoors. Serum 25(OH)D (29.0 ± 8.61, 19.1 ± 5.73 and 10.9 ± 4.19 ng/ml, respectively; P < 0.001), bioavailable 25(OH)D and free 25(OH)D index were maximum in outdoor workers followed by mixed-exposure and indoor workers. Their mean serum DBP levels (241.2 ± 88.77, 239.3 ± 83.40 and 216.6 ± 63.93 µg/ml, respectively; P = 0.12) were comparable. Mean serum iPTH was significantly lower in outdoor than indoor workers and showed inverse correlations with serum 25(OH)D, bioavailable 25(OH)D and free 25(OH)D index (r = -0.401, -0.269 and -0.236, respectively; P < 0.001 in all). Daily dietary-calorie intake was higher and calcium lower in outdoor than indoor workers. On regression analysis, sun-exposure was the only significant variable, increasing serum 25(OH)D by 2.03 ng/ml per hour of sun-exposure (95 % confidence interval 1.77-2.28; P < 0.001). Outdoor workers with prolonged sun-exposure were vitamin D-sufficient, with higher serum bioavailable 25(OH)D than the indoor workers during summer. Use of serum DBP levels did not affect the interpretation of their vitamin D status.

Objective: There is limited information on seizures in patients with idiopathic hypoparathyroidism (IH). We assessed seizure characteristics at presentation, subclinical seizures during follow-up, and the effect of antiepileptic drug (AED) withdrawal in IH patients. Designs and methods: Seizure characteristics were assessed in 70 patients with IH attending endocrine clinic. Provoked electroencephalography (EEG) was performed for subclinical seizures in 44 of them. AEDs were withdrawn using strict criteria, i.e. i) no seizure during past 2 years, ii) normal EEG, iii) serum total calcium R1.8 mmol/l, and iv) feasibility to follow-up regularly after AED withdrawal for at least 9 months (nZ14). The effects of AED withdrawal on seizures and serum total calcium were assessed. Results: Seizures were present in 64.3% of patients, generalized tonic-clonic in 86.7%, and treated with phenytoin (46.7%), valproate (40%), and carbamazepine (26.7%). Most (69/70) patients were seizure-free during the follow-up of 6.6G4.5 years. Ten of 14 (71.4%) patients were successfully withdrawn from AED and remained seizure free during the follow-up period of 13.5G2.4 months (range 9-18). AEDs were restarted because of the recurrence of seizures (nZ3) and poor compliance with calcium/vitamin D (nZ1). The mean serum total calcium increased from 1.9G0.19 to 2.1G0.14 mmol/l after AED withdrawal (PZ0.004). Conclusion: Seizures were present in 64.3% of patients with IH and they responded to AED and calcium/1-a-(OH)D during the follow-up. With strict eligibility criteria, it was possible to withdraw AED in 71% of patients with IH. Serum total calcium improved significantly after AED withdrawal.

The presence of several osteogenic molecules in caudate nucleus indicates that BGC would probably be the outcome of an active process. The differences in expression of these molecules in caudate over gray matter could favor BGC at this site in the unique biochemical milieu of hypoparathyroid state.