J Korean Med Sci.  2012 Jun;27(6):636-643. 10.3346/jkms.2012.27.6.636.

Relationship between Vitamin D, Parathyroid Hormone, and Bone Mineral Density in Elderly Koreans

• Kim G
• Oh KW
• Jang EH
• Kim MK
• Lim DJ
• Kwon HS
• Baek KH
• Yoon KH
• Lee WC
• Cha BY
• Lee KW
• Son HY
• Kang MI

• KMID: 1421616
• DOI: http://doi.org/10.3346/jkms.2012.27.6.636

Abstract

There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged < or = 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.

Keyword

Vitamin D; Intact Parathyroid Hormone; Bone Density; Age; Sex

MeSH Terms

Absorptiometry, Photon
Age Factors
Aged
*Bone Density
Female
Femur/anatomy & histology
Humans
Hyperparathyroidism/diagnosis/etiology
Lumbosacral Region/anatomy & histology
Male
Middle Aged
Parathyroid Hormone/*blood
Postmenopause
Republic of Korea
Seasons
Sex Factors
Vitamin D/*analogs & derivatives/blood
Parathyroid Hormone
Vitamin D

Figure

• 

  Fig. 1 Relationship between serum (iPTH) and 25-hydroxyvitamin D (25(OH)D) values in men (A) and postmenopausal women (B). For a 25(OH)D concentration higher than 36.7 ng/mL, there is a plateau level at 41.6 pg/mL for iPTH in men. In women, the exponential decay function failed to identify a plateau for serum iPTH.

• 

  Fig. 2 Serum parathyroid hormone (PTH) levels according to 25(OH)D levels in different age groups. Mean iTPH in individuals older than 75 yr were consistently higher than that of those aged 65 yr or younger, except in the lowest (25(OH)D < 10 ng/mL) vitamin D group (ANOVA, Dunnett's multiple comparison test).

• 

  Fig. 3 Mean serum 25(OH)D and iPTH levels according to season and age in men and women. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001) and ≥ 70 yr (P = 0.018) in the winter and summer seasons, respectively. iPTH levels increased significantly in women aged ≥ 80 yr (P < 0.001; P < 0.001 after adjustment for creatinine clearance and BMI) and ≥ 70 yr (P = 0.018; P = 0.043 after adjustment for creatinine clearance and BMI) in the winter and summer seasons, respectively. Black boxes indicate men and blank circles indicate women; Dashed lines indicate mean values adjusted for BMI and creatinine clearance; Numbers in squared brackets indicate numbers of men and numbers in round brackets indicates numbers of postmenopausal women, respectively (ANOVA, Dunnett's multiple comparison test, ANCOVA, Bonferroni's multiple comparison).

Reference

1. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001. 22:477–501.

2. Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF. An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporos Int. 1999. 9:394–397.

3. Boiullon R. DeGroot LJ, Jameson JL, editors. Vitamin D: from photosynthesis, metabolism, and action to clinical applications. Endocrinology. 2001. Philadelphia: W.B. Saunders;1009–1028.

4. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006. 81:353–373.

5. Von Mühlen DG, Greendale GA, Garland CF, Wan L, Barrett-Connor E. Vitamin D, parathyroid hormone levels and bone mineral density in community-dwelling older women: The Rancho Bernardo Study. Osteoporos Int. 2005. 16:1721–1726.

6. Norris JM. Can the sunshine vitamin shed light on type 1 diabetes? Lancet. 2001. 358:1476–1478.

7. Ovesen L, Andersen R, Jakobsen J. Geographical differences in vitamin D status, with particular reference to European countries. Proc Nutr Soc. 2003. 62:813–821.

8. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA. Hypovitamaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr. 2002. 76:187–192.

9. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998. 351:805–806.

10. McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med. 1992. 93:69–77.

11. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005. 16:713–716.

12. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006. 84:18–28.

13. Maggio D, Cherubini A, Lauretani F, Russo RC, Bartali B, Pierandrei M, Ruggiero C, Macchiarulo MC, Giorgino R, Minisola S, et al. 25(OH)D serum levels decline with age earlier in women than in men and less efficiently prevent compensatory hyperparathyroidism in older adults. J Gerontol A Biol Sci Med Sci. 2005. 60:1414–1419.

14. Vieth R, Ladak Y, Walfish PG. Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab. 2003. 88:185–191.

15. Sai AJ, Walters RW, Fang X, Gallagher JC. Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab. 2011. 96:E436–E446.

16. Kwon HS, Park YM, Lee HJ, Lee JH, Choi YH, Ko SH, Lee JM, Kim SR, Kang SY, Lee WC, et al. Prevalence and clinical characteristics of the metabolic syndrome in middle-aged Korean adults. Korean J Intern Med. 2005. 20:310–316.

17. Ahn Y, Lee JE, Cho NH, Shin C, Park C, Oh BS, Kimm K. Validation and calibration of semi-quantitative food frequency questionnaire, with participants of the Korean health and genome study. Korean J Community Nutr. 2004. 9:173–182.

18. Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab. 2004. 89:3152–3157.

19. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997. 7:439–443.

20. Nakamura K, Tsugawa N, Saito T, Ishikawa M, Tsuchiya Y, Hyodo K, Maruyama K, Oshiki R, Kobayashi R, Nashimoto M, et al. Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study. Bone. 2008. 42:271–277.

21. Arabi A, Baddoura R, Awada H, Salamoun M, Ayoub G, El-Hajj Fuleihan G. Hypovitaminosis D osteopathy: is it mediated through PTH, lean mass, or is it a direct effect? Bone. 2006. 39:268–275.

22. Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD. Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ. 1993. 307:172–173.

23. Ebeling PR, Sandgren ME, DiMagno EP, Lane AW, DeLuca HF, Riggs BL. Evidence of an age-related decrease in intestinal responsiveness to vitamin D: relationship between serum 1,25-dihydroxyvitamin D3 and intestinal vitamin D receptor concentrations in normal women. J Clin Endocrinol Metab. 1992. 75:176–182.

24. Pattanaungkul S, Riggs BL, Yergey AL, Vieira NE, O'Fallon WM, Khosla S. Relationship of intestinal calcium absorption to 1,25-dihydroxyvitamin D [1,25(OH)2D] levels in young versus elderly women: evidence for age-related intestinal resistance to 1,25(OH)2D action. J Clin Endocrinol Metab. 2000. 85:4023–4027.