Vitamin D deficiency influences histomorphometric features of bone in primary hyperparathyroidism

Stein, Emily; Dempster, David W.; Udesky, Julia; Zhou, Hua; Bilezikian, John P.; Shane, Elizabeth; Silverberg, Shonni J.

doi:10.1016/j.bone.2010.10.004

Cited by 58 publications

(36 citation statements)

References 28 publications

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“…This is in accordance with most other studies (47). Furthermore, a histomorphometric study of 30 patients with mild PHPT revealed that low levels of 25OHD were associated with higher concentrations of PTH, greater catabolic effects in the cortical bone and greater anabolic effects in the trabecular bone (50).…”

Section: Vitd Insufficiency In Phpt: Prevalence and Aetiologysupporting

confidence: 91%

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Bollerslev

Marcocci

Sosa

et al. 2011

European Journal of Endocrinology

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Management of patients with mild primary hyperparathyroidism (PHPT) has been widely discussed because most patients today do not have specific symptoms. While surgery is always an option, the recommendations for treatment have shifted, which mostly reflects changes in clinical practice. In this study, we aimed to evaluate evidence for the current recommendations concerning operation vs observation, repletion with vitamin D (VitD) and alternative medical management.Surgery is followed by normalisation of calcium and parathyroid hormone (PTH) and a decrease in bone turnover followed by an increase in bone mass. It is not known what the consequences would be for the frequency of fractures. Randomised studies have indicated beneficial effects of operation on quality of life (QoL), but the effects have been minor and inconsistent. Operation seems not to be superior to observation for cardiovascular risk factors. Although PHPT patients in average have slightly decreased plasma 25OH VitD, severe symptomatic VitD deficiency seems not to be a characteristic of PHPT patients in Europe. However, if present, we recommend VitD substitution before final decision on surgical treatment. It is unknown whether routine VitD supplementation should be offered preoperatively to all patients with mild PHPT or as part of long-term medical treatment.Targeted medical management could be an option for patients with contraindications to surgery. Antiresorptive therapy might be appropriate for patients with a low bone mass to prevent further bone loss. Calcimimetics could be tried to control serum calcium levels although there is no evidence of an effect on the hypercalcaemic symptoms or the QoL. Combined therapy with calcimimetics and alendronate could be considered for patients with hypercalcaemia and overt bone disease.

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Section: Vitd Insufficiency In Phpt: Prevalence and Aetiologysupporting

confidence: 91%

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Bollerslev

Marcocci

Sosa

et al. 2011

European Journal of Endocrinology

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“…On the other hand, the younger age at diagnosis could argue that the disease is truly more severe in China. The markedly lower serum 25(OH)D levels in the Chinese subjects, in the range where PHPT has been shown to be much more severe (15), argues for this point. Although it is noteworthy that serum 25(OH)D levels are higher now in the Shanghai PHPT population than the cohort described from Beijing (13 vs. 8.8 ng·mL -1 ), the levels are still very low.…”

Section: Discussionmentioning

confidence: 92%

Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

et al. 2013

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In the 1970s, with the advent of biochemical multichannel screening in the United States and other western countries, the clinical presentation of primary hyperparathyroidism (PHPT) changed from a symptomatic to an asymptomatic disorder. However, in Asian countries, like China, PHPT did not show this evolution, but rather continued to be a symptomatic disease with target organ involvement. In this paper, we revisit the clinical features of PHPT in New York and Shanghai, representative United States and Chinese cites, over the past decade. The questions we address are whether the disease evolved in China to a more asymptomatic one and, whether in the United States further changes are evident. The results indicate that while PHPT continues to present primarily as an asymptomatic disease in the United States, a new phenotype characterized by normal serum calcium and high parathyroid hormone levels, normocalcemic PHPT, has emerged. Data from Shanghai demonstrates a trend for PHPT to present more commonly as an asymptomatic disorder in China. However, most patients with PHPT in China still manifest classical symptoms, i.e. nephrolithiasis and fractures. A comparison of the two cohorts shows that Chinese patients with PHPT are younger, with higher serum calcium and PTH levels, and lower 25-hydroxyvitamin D levels than patients in New York. Normocalcemic PHPT has not yet been recognized in Shanghai. In summary, although the phenotypes of PHPT in both cities are evolving towards less evident disease, sharp clinical and biochemical differences are still apparent in PHPT as expressed in China and the United States. Keywords: normocalcemic primay hyperparathyroidism; asymptomatic; symptomatic Bone Research (2013) 2: 162-169. doi: 10.4248/BR201302005 IntroductionIn countries that began to utilize the multichannel biochemical screening test in the 1970s, the presentation of primary hyperparathyroidism (PHPT) changed from a disease that was classically symptomatic with "stones, bones, moans and groans" to a contemporary asymptomatic disorder ( 1). While this clinical evolution was apparent in the United States and other Western countries, in Asian countries, such as India and China, In this paper, we review the more recent experience in two cities, Shanghai and New York, with the central question: has the clinical expression of PHPT changed in these countries over the past 10 years? MethodsThe cohort from Shanghai has recently been reported (4). These subjects form the basis for the description of the more recent experience in China. In the United States, an ongoing new cohort of subjects since 2010 form the basis of the New York experience, along with a published experience of subjects who present with normocalcemic PHPT (5-6). As opposed to asymptomatic cases, symptomatic PHPT refers to symptoms related with hypercalcemia, such as skeletal and renal diseases, neuromuscular, gastrointestinal, articular, hematologic, cardiovascular and central nervous system manifestations. Statistical analysesAll statistical analyses were pe...

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“…[29][30][31]50 The striking contrast between the effects of PHPT on cancellous bone (preservation) and cortical bone (loss) at the iliac crest was recently highlighted in a study in which our laboratory documented the effects of vitamin D deficiency on bone structure in patients with PHPT. 66 We studied 30 patients with PHPT, the majority of whom were women. Serum 25 hydroxyvitamin D (25OHD) concentrations were low in the majority of subjects (21 ± 11 ng/ml) and were correlated inversely with PTH.…”

Section: Conventional Indices Of Bone Structurementioning

confidence: 99%

Bone Histomorphometry and Bone Quality in Primary Hyperparathyroidism

et al. 2015

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Vitamin D deficiency influences histomorphometric features of bone in primary hyperparathyroidism

Cited by 58 publications

References 28 publications

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

Bone Histomorphometry and Bone Quality in Primary Hyperparathyroidism

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