Bone Mineral Density Increases with Vitamin D Repletion in Patients with Coexistent Vitamin D Insufficiency and Primary Hyperparathyroidism

Kantorovich, V.

doi:10.1210/jc.85.10.3541

Cited by 67 publications

(82 citation statements)

References 4 publications

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“…These non-CF studies had determined that 50,000 IU of oral ergocalciferol once or twice weekly for several weeks significantly repleted 25-OHD levels in most patients who were deficient (22)(23)(24). The results of our study, however, suggest that this repletion regimen is strikingly ineffective in CF.…”

Section: Discussioncontrasting

confidence: 57%

Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic Fibrosis

Boyle

Noschese

Watts

et al. 2005

Am J Respir Crit Care Med

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Survival has steadily improved in cystic fibrosis (CF) over the last few decades, with the median survival age now older than 33 years, and over 40% of all individuals with CF older than 18 years (1). With this increase in survival, there has also been growing recognition of health issues unique to the adult population with CF (2). One of these issues is bone health, because studies using dual-energy x-ray absorptiometry measurements of bone density have determined that, despite their young age, approximately 20 to 25% of adults with CF have osteoporosis and another 40% have osteopenia (3-5). The etiology of this bone disease is multifactorial, with contributors including fat malabsorption (resulting in vitamin D malabsorption and abnormal calcium metabolism) (6-8), glucocorticoid therapy (9, 10), poor nutritional status (11), inadequate gonadal hormones (10, 12), and elevated circulating cytokines (13). Recognition of this increased risk of osteoporosis in CF has led to greater efforts to optimize vitamin D status and calcium absorption (4,14). The overall prevalence of vitamin D deficiency in adults with CF is strikingly high, with as many as 50 to 60% having 25-hydroxyvitamin D (25-OHD) levels below 20 ng/ml (5, 15). Data demonstrating that serum 25-OHD levels need to exceed 30 ng/ml to prevent a rise in serum parathyroid hormone (16) suggest that the prevalence of vitamin D deficiency in CF may be even higher.Because of the growing concern about bone disease in CF, the U.S. Cystic Fibrosis Foundation (CFF) convened a panel of experts to develop consensus treatment guidelines to optimize CF bone health, and these recommendations were recently published (17). The guidelines contained several specific recommendations regarding vitamin D. First, greater attention to maintaining adequate serum 25-OHD levels should occur, with levels being checked annually in the late fall with the goal of maintaining serum 25-OHD between 30 and 60 ng/ml (75-150 nmol/L). Second, all individuals with CF who are older than 1 year should receive 800 IU/day of oral ergocalciferol (vitamin D 2 ). Failure of this supplementation to maintain serum 25-OHD levels above 30 ng/ml should lead to aggressive repletion with high-dose oral ergocalciferol. The guidelines recommended a stepped approach for repletion, with an initial regimen of 50,000 IU/week of oral ergocalciferol for 8 weeks. Failure of this regimen to raise serum 25-OHD to over 30 ng/ml should lead to a second course of oral ergocalciferol with 50,000 IU/twice weekly for 8 weeks. Persistence of serum 25-OHD levels below 30 ng/ml despite these supplemental regimens should result in consideration of alternative modes of therapy, such as calcitriol or phototherapy. This treatment protocol was developed on the basis of data in individuals without CF, but was recognized as a "first step" in addressing the clear need for more aggressive vitamin D therapy in individuals with CF. Conference leaders stated a need for CF-specific data in the future on which to determine optimal dosing rec...

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Section: Discussioncontrasting

confidence: 57%

Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic Fibrosis

Boyle

Noschese

Watts

et al. 2005

Am J Respir Crit Care Med

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“…There are controversies about the effect of vitamin D repletion on BMD at lumbar spine and femur neck. Some authors suggest that BMD is increased with repletion in both sites whereas others claim that 25 OHD has no independent effect on BMD (22,23). Besides the negative effects on BMD, low vitamin D levels may contribute to profound and lengthened hypocalcaemia (hungry bone syndrome) after parathyroidectomy (20).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

Çakır

Polat

Kılıç

et al. 2016

Arch. Endocrinol. Metab.

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Objective: Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don't fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods: Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results: Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion: Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery. Arch Endocrinol Metab. 2016;60(6):537-44

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“…Elevated PTH due to vitamin D deficiency will return to normal levels in most healthy individuals without CKD after correction of vitamin D status (26,27).…”

Section: Discussionmentioning

confidence: 99%

Cholecalciferol (Vitamin D3) Therapy and Vitamin D Insufficiency in Patients with Chronic Kidney Disease: A Randomized Controlled Pilot Study

Binongo²,

et al. 2008

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Objective-To investigate the efficacy of cholecalciferol (vitamin D 3 ) in raising serum ]D) levels and reducing parathyroid hormone (PTH) levels in patients with chronic kidney disease (CKD).Methods-In this double-blind, randomized controlled pilot study, participants with CKD stage 3 and 4 (estimated glomerular filtration rate, 15-59 mL/min/1.73 m 2 ), vitamin D insufficiency (serum 25[OH]D <30 ng/mL), and serum intact PTH levels >70 pg/mL were randomly assigned to receive either 50 000 IU of cholecalciferol or placebo once weekly for 12 weeks. Primary outcomes (25[OH] D and PTH levels) were measured at baseline, week 6, and week 12. Secondary outcomes (1,25-dihydroxvitamin D and bone turnover markers) were measured at baseline and week 12. Because of skewed data distribution, statistical analyses were performed on a logarithmic scale. The difference between the group means was exponentiated to provide the geometric mean ratio. A linear mixed model using an unstructured variance-covariance matrix was used to examine change in the primary and secondary outcomes over time.Results-Geometric mean serum 25(OH)D concentrations of the study groups were similar at baseline (P = .77). At week 6, a significant difference between the treatment and placebo groups was detected (P = .001); this difference was maintained at week 12 (P = .002). Among cholecalciferoltreated participants, serum 25(OH)D concentration increased on average from 17.3 ng/mL (95% confidence interval [CI],.2) at baseline to 49.4 ng/mL (95% CI, 33.9-72.0) at week 12. Astreated analysis indicated a trend toward lower PTH levels among cholecalciferol-treated participants (P = .07). Conclusion-Weekly cholecalciferol supplementation appears to be an effective treatment to correct vitamin D status in patients with CKD.

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Bone Mineral Density Increases with Vitamin D Repletion in Patients with Coexistent Vitamin D Insufficiency and Primary Hyperparathyroidism

Cited by 67 publications

References 4 publications

Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic Fibrosis

Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic Fibrosis

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

Cholecalciferol (Vitamin D3) Therapy and Vitamin D Insufficiency in Patients with Chronic Kidney Disease: A Randomized Controlled Pilot Study

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