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  • Title: Parathyroid response to vitamin D insufficiency: relations to bone, body composition and to lifestyle characteristics.
    Author: Rejnmark L, Vestergaard P, Brot C, Mosekilde L.
    Journal: Clin Endocrinol (Oxf); 2008 Jul; 69(1):29-35. PubMed ID: 18208576.
    Abstract:
    BACKGROUND: Vitamin D insufficiency is very common and is known to cause secondary hyperparathyroidism (SHPT). However, in some subjects the PTH response to low vitamin D levels is blunted, which has been termed functional hypoparathyroidism (FHPT). AIM: We compared indices of calcium homeostasis, bone metabolism and body composition in subjects with differential PTH responses to low vitamin D levels. DESIGN: Cross-sectional study. In 405 recent postmenopausal women with vitamin D insufficiency, we compared levels of bone turnover markers, bone mineral density (BMD), body composition, and body weight between subjects with SHPT and FHPT. RESULTS: Plasma 25-hydroxyvitamin D (P-25OHD) levels were slightly higher (P < 0.05) in SHPT compared with FHPT. SHPT was associated with higher levels of osteocalcin and bone-specific alkaline phosphatase, whereas whole body BMD and hip- and lumbar spine-BMD were significantly reduced. Subjects with SHPT had a 7% (P < 0.01) higher body weight and a 23% higher fat mass (P < 0.01) than subjects with FHPT, whereas lean tissue mass did not differ between groups. In SHPT, fat mass was increased by 14% (P < 0.001) at the upper and lower extremities and by 33% (P < 0.001) at the trunk. In a regression model, significant predictors of fat mass was P-PTH (r(p) = 0.248, P < 0.01) and P-osteocalcin (r(p) = -0.115, P = 0.02), with no effects of P-25OHD or P-creatinine levels. CONCLUSIONS: Effects of vitamin D insufficiency on bone is associated with the PTH responses. The increased body weight and fat mass in SHPT compared with FHPT may imply that PTH excess contributes to fat accumulation.
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