Reliability of parathyroid hormone measurements in the period immediately following hip fracture

Johansen, Antony; Stone, Mike; O'Mahony, M Sinead; Westlake, Helen; Woodhead, J. S.; Woodhouse, Ken

doi:10.1093/ageing/26.3.175

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Our observation of no change in PTH following EHR is in agreement with other studies [31]. The decrease in serum PTH following HF reported in this study is in agreement with a study of 24 elderly patients with HF before surgery, immediately after surgery and at 2 weeks and 3 months after fracture [32].…”

Section: Discussionsupporting

confidence: 93%

“…Serum variables were measured, on average, 1 day after admission. While some authors do not find that PTH is affected if measured immediately following hip fracture [31], according to others, measurement immediately after the fracture may overestimate the prevalence of secondary hyperparathyroidism [32]. Moreover, the ionized calcium values were calculated instead of measured.…”

Section: Discussionmentioning

confidence: 99%

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Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing

Vaculík

Wenchich

Bobelyak

et al. 2021

J Endocrinol Invest

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Objective To assess the decrease in serum calcitriol concentrations after hip fracture. Methods Serum concentrations of calcitriol, 25(OH)D, parathyroid hormone (PTH), directly measured free 25(OH)D, and indices of bone formation were measured in elderly patients with hip fracture (HF) and patients with elective hip replacement (EHR) at admission and after 7 weeks. Results A total of 45 patients with HF and 17 patients with EHR completed this prospective study. Baseline serum calcitriol levels were ≤ 60 pmol/l in 26% of the HF patients. After 7 weeks, they significantly decreased (p < 0.001). In patients with EHR, serum calcitriol was within the reference range in all but one patient and did not change during the 7-week recovery phase. Seven weeks after HF, a significant positive relationship was observed between the change in calcitriol and serum 25(OH)D concentration (r = 0.385, p = 0.009) and free 25(OH)D (r = 0.296, p = 0.048), and a decrease in calcitriol during recovery was associated with a decrease in serum PTH (p = 0.038). Seven weeks after HF, changes in both serum PTH and serum 25(OH)D concentrations contributed to the prediction of changes in serum calcitriol (R 2 = 0.190, p = 0.012). Conclusions Unlike patients with EHR, subjects with HF had low serum 25(OH)D and low free 25(OH)D concentrations at admission, while their serum 1,25D levels were relatively elevated. Decreases in circulating calcitriol levels in the 7 weeks following hip surgery were associated with a resolution of secondary hyperparathyroidism and low availability of free 25(OH)D.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing

Vaculík

Wenchich

Bobelyak

et al. 2021

J Endocrinol Invest

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“…However, PTH can vary significantly over a short period and the impact on serum measurements from fracture and subsequent trauma is not well understood. One study showed elevated PTH levels immediately after hip fracture that fell significantly two weeks later [58], while others have reported serum levels increasing [59] or remaining stable [60] during hip fracture recovery. Comparatively, 25(OH)D has a much longer half-life in circulation and studies have consistently showed no changes in 25(OH)D levels from post-fracture through to recovery [58,61].…”

Section: Discussionmentioning

confidence: 99%

Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies

et al. 2010

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BackgroundVitamin D supplementation for fracture prevention is widespread despite conflicting interpretation of relevant randomised controlled trial (RCT) evidence. This study summarises quantitatively the current evidence from RCTs and observational studies regarding vitamin D, parathyroid hormone (PTH) and hip fracture risk.MethodsWe undertook separate meta-analyses of RCTs examining vitamin D supplementation and hip fracture, and observational studies of serum vitamin D status (25-hydroxyvitamin D (25(OH)D) level), PTH and hip fracture. Results from RCTs were combined using the reported hazard ratios/relative risks (RR). Results from case-control studies were combined using the ratio of 25(OH)D and PTH measurements of hip fracture cases compared with controls. Original published studies of vitamin D, PTH and hip fracture were identified through PubMed and Web of Science databases, searches of reference lists and forward citations of key papers.ResultsThe seven eligible RCTs identified showed no significant difference in hip fracture risk in those randomised to cholecalciferol or ergocalciferol supplementation versus placebo/control (RR = 1.13[95%CI 0.98-1.29]; 801 cases), with no significant difference between trials of <800 IU/day and ≥800 IU/day. The 17 identified case-control studies found 33% lower serum 25(OH)D levels in cases compared to controls, based on 1903 cases. This difference was significantly greater in studies with population-based compared to hospital-based controls (χ21 (heterogeneity) = 51.02, p < 0.001) and significant heterogeneity was present overall (χ216 (heterogeneity) = 137.9, p < 0.001). Serum PTH levels in hip fracture cases did not differ significantly from controls, based on ten case-control studies with 905 cases (χ29 (heterogeneity) = 149.68, p < 0.001).ConclusionsNeither higher nor lower dose vitamin D supplementation prevented hip fracture. Randomised and observational data on vitamin D and hip fracture appear to differ. The reason for this is unclear; one possible explanation is uncontrolled confounding in observational studies. Post-fracture PTH levels are unrelated to hip fracture risk.

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“…In the literature, studies on adult patients shown that serum calcium levels are elevated after fractures. This can be explained by bone resorption and decreased bone formation 23,24 . The results of studies showing the relationship between phosphorus level and bone fractures are contradictory [25][26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

Klavikula kırığı saptanan yenidoğan hastalarda serum D vitamini düzeyleri

Aygün

Tüfekçi

SEMERCİ

2022

Cukurova Medical Journal

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Öz Purpose:The aim of this study was to determine the possible role of vitamin D on the clavicle fracture in the newborn. Materials and Methods: This retrospective crosssectional study was conducted between 2018-2020. Infants who were admitted to neonatal intensive care unit due to the clavicle fracture were included. Infants who did not have a fracture, but were admitted to the hospital for reasons instead of exclusion criteria were included as the control group. Birth weight, height, head circumference, gender, gestational week, delivery type, other clinical findings such as brachial plexus paralysis in the infant, maternal age, number of pregnancies, risk factors time to diagnosis were recorded. According to the serum 25-OH vitamin D levels, newborns were classified as having normal vitamin D status (>30 ng/mL), vitamin D insufficient (between 20-30 ng/mL), or deficiency (<20 ng/mL). Groups were compared for the vitamin D levels, the demographics and clinical characteristics. Results: A total of 48 infants were included. The groups did not differ in terms of demographics. Age of diagnosis ranged from postnatal 1 to 6 days of life. Serum calcium levels were significantly lower in the case group. Although phosphorus and alkaline phosphatase levels did not differ between groups, vitamin D levels were significantly lower in the case group. Conclusion:This study shows that newborns with clavicle fracture had lower vitamin D levels. Cautious palpation of the clavicle can catch the fracture before the hospital discharge even there is no evident symptom and serum vitamin D level of those infants should be checked in order to detect the possible deficiency timely. Amaç: Bu çalışmada yenidoğan döneminde klavikula kırığı üzerine D vitamininin olası rolünün belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif kesitsel çalışma 2018-2020 yılları arasında yapılmıştır. Klavikula kırığı nedeniyle yenidoğan yoğun bakım ünitesinde izlenen bebekler çalışmaya alındı. Kontrol grubu kırığı olmayan ancak dışlama kriterleri dışındaki nedenlerle hastaneye başvuran bebeklerden oluşturuldu. Doğum ağırlığı, boyu, baş çevresi, cinsiyeti, gebelik haftası, doğum şekli, bebekte brakiyal pleksus felci gibi diğer klinik bulgular, anne yaşı, gebelik sayısı, tanı zamanı ve risk faktörleri kaydedildi. Yenidoğanlar serum 25-OH D vitamini düzeylerine göre D vitamini düzeyi normal (>30 ng/mL), D vitamini yetersiz (20-30 ng/mL) veya eksikliği olanlar (<20 ng/mL) olarak sınıflandırıldı. Gruplar D vitamini düzeyleri, demografik ve klinik özellikler açısından karşılaştırıldı. Bulgular: Çalışmamıza 48 bebek dahil edildi. Gruplar demografik açıdan benzer bulundu. Klavikula kırığı için tanı yaşı doğum sonrası 1 ila 6 gündü. Serum kalsiyum düzeyleri vaka grubunda anlamlı olarak daha düşüktü. Fosfor ve alkalin fosfataz düzeyleri gruplar arasında farklılık göstermemesine rağmen, D vitamini düzeyleri vaka grubunda anlamlı derecede düşüktü. Sonuç: Bu çalışma, klavikula kırığı olan yenidoğan bebeklerde D vitamini düzeylerinin düşük olduğunu göstermiştir. ...

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Reliability of parathyroid hormone measurements in the period immediately following hip fracture

Abstract: Measurements of PTH performed during inpatient care of those with hip fracture appear sufficiently reliable for use in assessment of metabolic status.

Cited by 7 publications

References 14 publications

Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing

Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing

Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies

Klavikula kırığı saptanan yenidoğan hastalarda serum D vitamini düzeyleri

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