Preliminary Findings: 25(OH)D Levels and PTH Are Indicators of Rapid Bone Accrual in Pubertal Children

Tylavsky, Frances A.; Ryder, Kathryn; Li, Rongling; Park, Vicki; Womack, Catherine; Norwood, John; Carbone, Laura D; Cheng, Sulin

doi:10.1080/07315724.2007.10719637

Cited by 37 publications

(20 citation statements)

References 28 publications

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“…(34,35) Our data do not support the hypothesis that elevated PTH levels are a relevant marker of altered bone mass accrual during puberty inasmuch as PTH levels in the highnormal range may favor bone formation and therefore not be detrimental to bone health during growth. (45) Assays of the other bone markers have not been informative in terms of understanding the mechanism(s) underlying the defective mineralization of girls' lumbar spine during late puberty. Low calcium intake is known to increase the efficiency of calcium absorption in adolescents.…”

Section: Discussionmentioning

confidence: 99%

Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls

Esterle

Nguyen

Walrant-Debray

et al. 2010

Journal of Bone and Mineral Research

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No consensus has been reached on the serum 25-hydroxyvitamin D [25(OH)D] levels required to ensure optimal bone health around menarche. We searched for a possible interaction of 25(OH)D levels and calcium intake on lumbar spine mineralization and on biologic features of bone metabolism in healthy late-pubertal girls. Lumbar spine parameters (ie, area, mineral content, and density) and calcium intake were evaluated in 211 healthy white adolescent girls at pubertal stages IV-V (11 to 16.9 years), together with biologic markers of calcium and bone metabolism and with International External Quality Assessment Scheme for Vitamin D Metabolite (DEQAS)-validated serum 25(OH)D levels. A high prevalence of 25(OH)D levels 30 nmol/L (41%), 40 nmol/L (61%), and 50 nmol/L (70%) was found during winter-spring. Parathyroid hormone (PTH) levels were inversely associated with 25(OH)D levels ( p ¼ .0021). In contrast, lumbar spine mineral content and density were not associated with 25(OH)D, excepted when calcium intake was below 600 mg/day ( p ¼ .0081). Girls with such low calcium intake and 25(OH)D levels of 40 nmol/L or less (9% of the cohort) had a 0.4 to 0.7 SD lower mean areal bone mineral density Z-score than girls with higher calcium intake and/or higher 25(OH)D status. The adverse association between lumbar spine mineralization and combined calcium deficiency-low 25(OH)D levels remained significant in the 91 girls who could be followed over 4 years after their initial evaluation. We conclude that low 25(OH)D levels ( 40 nmol/L) are observed frequently during winterspring in late-pubertal European girls, which may exacerbate the negative impact of calcium deficiency on lumbar spine mineralization. ß

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Section: Discussionmentioning

confidence: 99%

Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls

Esterle

Nguyen

Walrant-Debray

et al. 2010

Journal of Bone and Mineral Research

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“…Although ergocalciferol did not lower PTH levels in Stage V renal failure, symptoms including fatigue, skeletal and muscle pain significantly improved in adult patients [17,66]. In children with normal renal function, 25-hydroxyvitamin D levels may influence bone accrual in pubertal children [67,68]; this relationship requires further studies in children with renal failure. 3.…”

Section: Assessment Of Bone Mineral Densitymentioning

confidence: 98%

Mineral metabolism and bone abnormalities in children with chronic renal failure

Sanchez

2008

Rev Endocr Metab Disord

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Abnormalities in mineral metabolism and changes in skeletal histology may contribute to growth impairment in children with chronic renal failure. Hyperphosphatemia, hypocalcemia, metabolic acidosis, alterations in vitamin D and IGF synthesis and parathyroid gland dysfunction play significant roles in the development of secondary hyperparathyroidism and subsequently, bone disease in renal failure. The recent KDIGO conference has made recommendations to consider this as a systemic disorder (chronic kidney disease-mineral bone disorder) and to standardize bone histomorphometry to include bone turnover, mineralization and volume (TMV). The use of DXA to assess bone mass is controversial in children with chronic renal failure. Questions arise regarding the accuracy of bone measurements and difficulty in data interpretation especially in children with renal failure who are not only growth retarded but often have pubertal delay and osteosclerosis. The validity and feasibility of new modalities of skeletal imaging which can detect changes in both trabecular and cortical bone are currently being investigated in children. The management of mineral abnormalities and bone disease in chronic renal failure is multifactorial. To manage hyperphosphatemia, dietary phosphate restriction accompanied by intake of calcium-free and metal-free phosphate binding agents are widely utilized. Vitamin D analogs remain the primary therapy for secondary hyperparathyroidism, although the use of the less hypercalcemic agents is preferred due to concerns of calciphylaxis and vascular calcification. Future clinical studies are needed to evaluate the long-term effects of calcimimetic agents and bisphosphonate therapy in children with chronic renal failure.

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“…Sufficiently high calcium intakes suppress iPTH release and therefore, conversion to 1,25(OH) 2 D. Calcium intake in the vitamin D supplementation study by Park et al [102] was~1000 mg/d, which may have been sufficient to suppress iPTH release, but does not explain the inverse relationship between serum 25(OH) D and calcium absorption. The inverse relationship between serum 25(OH)D and iPTH may explain the decreased calcium absorption at higher 25(OH)D concentrations through decreased conversion to 1,25(OH) 2 D. Indeed, serum 1,25(OH) 2 D has been shown to be positively correlated with calcium absorption efficiency in adolescent girls (r ¼ 0.35, P ¼ e0.001) [90]. Calcium absorption is influenced by an interaction of calcium intake and genetics, as well as diet.…”

Section: Fractional Calcium Absorptionmentioning

confidence: 91%

“…In one such prospective study, female adolescents that had the greatest BMC gains at the spine, total hip and radius over a period of 1e7 years, were also in the lowest quartiles for plasma 25(OH)D [113]. Similarly, inverse relationships were reported between baseline serum 25(OH)D and 2-year changes in total body BMC [90] or 1-year changes in BMC of the spine (r ¼ e0.20), femoral neck (r ¼ e0. 16), and radius (r ¼ e0.17) following supplementation [82].…”

Section: Vitamin D and Bonementioning

confidence: 91%

Adolescence and Acquisition of Peak Bone Mass

2011

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Preliminary Findings: 25(OH)D Levels and PTH Are Indicators of Rapid Bone Accrual in Pubertal Children

Abstract: High normal PTH with low-normal 25(OH)D stores and moderate to high calcium intake may be beneficial to accruing larger bone size and BMC during puberty.

Cited by 37 publications

References 28 publications

Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls

Adverse interaction of low-calcium diet and low 25(OH)D levels on lumbar spine mineralization in late-pubertal girls

Mineral metabolism and bone abnormalities in children with chronic renal failure

Adolescence and Acquisition of Peak Bone Mass

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