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. 1970 Jan 10;1(5688):76–79. doi: 10.1136/bmj.1.5688.76

Secondary Hyperparathyroidism in Osteomalacia

N C Thalassinos, Susan Wicht, G F Joplin
PMCID: PMC1699112  PMID: 5411449

Abstract

Twenty-one patients with histologically proved osteomalacia from various causes were investigated for biochemical and radiological evidence of osteomalacia and secondary hyperparathyroidism. Among the 15 who maintained a normal serum calcium, seven had a raised phosphate excretion index, seven had a raised serum alkaline phosphatase, and six had phalangeal erosions. On the other hand, six patients had a subnormal serum calcium; of these, none showed a raised phosphate excretion index, one had a raised serum alkaline phosphatase, and one had erosions. The phosphate excretion index and the alkaline phosphatase were strongly correlated (r = +0·84). It is concluded that this absence of manifest secondary hyperparathyroidism in some patients with osteomalacia is due to failure of an increase in the release of parathyroid hormone. Measurement of phosphaturia does not appear to be a useful means of detecting osteomalacia. Subsequently, the 24-hour (stable) strontium space measurement was found to be the most sensitive single biochemical screening test for osteomalacia.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnaud C. D., Jr, Tenenhouse A. M., Rasmussen H. Parathyroid hormone. Annu Rev Physiol. 1967;29:349–372. doi: 10.1146/annurev.ph.29.030167.002025. [DOI] [PubMed] [Google Scholar]
  2. Arnstein A. R., Frame B., Frost H. M. Recent progress in osteomalacia and rickets. Ann Intern Med. 1967 Dec;67(6):1296–1330. doi: 10.7326/0003-4819-67-6-1296. [DOI] [PubMed] [Google Scholar]
  3. Au W. Y., Raisz L. G. Effect of vitamin D and dietary calcium on parathyroid activity. Am J Physiol. 1965 Sep;209(3):637–642. doi: 10.1152/ajplegacy.1965.209.3.637. [DOI] [PubMed] [Google Scholar]
  4. BEUTNER E. H., MUNSON P. L. Time course of urinary excretion of inorganic phosphate by rats after parathyroidectomy and after injection of parathyroid extract. Endocrinology. 1960 Apr;66:610–616. doi: 10.1210/endo-66-4-610. [DOI] [PubMed] [Google Scholar]
  5. Bartos H. R., Henneman P. H. Parathyroid hyperplasia in osteomalacia. J Clin Endocrinol Metab. 1965 Nov;25(11):1522–1523. doi: 10.1210/jcem-25-11-1522. [DOI] [PubMed] [Google Scholar]
  6. Bordier P., Matrajt H., Hioco D., Hepner G. W., Thompson G. R., Booth C. C. Subclinical vitamin-D deficiency following gastric surgery. Histological evidence in bone. Lancet. 1968 Mar 2;1(7540):437–440. doi: 10.1016/s0140-6736(68)92777-3. [DOI] [PubMed] [Google Scholar]
  7. DeLuca H. F. Mechanism of action and metabolic fate of vitamin D. Vitam Horm. 1967;25:315–367. doi: 10.1016/s0083-6729(08)60039-4. [DOI] [PubMed] [Google Scholar]
  8. Estep H., Shaw W. A., Watlington C., Hobe R., Holland W., Tucker S. G. Hypocalcemia due to hypomagnesemia and reversible parathyroid hormone unresponsiveness. J Clin Endocrinol Metab. 1969 Jun;29(6):842–848. doi: 10.1210/jcem-29-6-842. [DOI] [PubMed] [Google Scholar]
  9. Evanson J. M. The response to the infusion of parathyroid extract in hypocalcaemic states. Clin Sci. 1966 Aug;31(1):63–75. [PubMed] [Google Scholar]
  10. FOURMAN P., HAAPANEN E. PARATHYROID FUNCTION IN STEATORRHOEA WITH OSTEOMALACIA. Schweiz Med Wochenschr. 1964 Jun 27;94:886–891. [PubMed] [Google Scholar]
  11. Fraser D., Kooh S. W., Scriver C. R. Hyperparathyroidism as the cause of hyperaminoaciduria and phosphaturia in human vitamin D deficiency. Pediatr Res. 1967 Nov;1(6):425–435. doi: 10.1203/00006450-196711000-00001. [DOI] [PubMed] [Google Scholar]
  12. GERSHBERG H., SHIELDS D. R., KOVE S. S. The acute effects of parathyroid extract in states of edema, diminished renal function and parathyroid disease. J Clin Endocrinol Metab. 1959 Jun;19(6):681–691. doi: 10.1210/jcem-19-6-681. [DOI] [PubMed] [Google Scholar]
  13. GOLDMAN R., BASSETT S. H. Phosphorus excretion in renal failure. J Clin Invest. 1954 Dec;33(12):1623–1628. doi: 10.1172/JCI103042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. HIATT H. H., THOMPSON D. D. The effects of parathyroid extract on renal function in man. J Clin Invest. 1957 Apr;36(4):557–565. doi: 10.1172/JCI103454. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. MILNE M. D., STANBURY S. W., THOMSON A. E. Observations on the Fanconi syndrome and renal hyperchloraemic acidosis in the adult. Q J Med. 1952 Jan;21(81):61–82. [PubMed] [Google Scholar]
  16. Mickerson J. N. Anterior Pituitary Deficiency in Disorders Associated with Steatorrhoea. Br Med J. 1960 Feb 20;1(5172):529–534. doi: 10.1136/bmj.1.5172.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. NORDIN B. E. Effect of malabsorption syndrome on calcium metabolism. Proc R Soc Med. 1961 Jun;54:497–500. doi: 10.1177/003591576105400610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. NORDIN B. E., FRASER R. Assessment of urinary phosphate excretion. Lancet. 1960 Apr 30;1(7131):947–951. doi: 10.1016/s0140-6736(60)90836-9. [DOI] [PubMed] [Google Scholar]
  19. RASMUSSEN H., DELUCA H., ARNAUD C., HAWKER C., VONSTEDINGK M. THE RELATIONSHIP BETWEEN VITAMIN D AND PARATHYROID HORMONE. J Clin Invest. 1963 Dec;42:1940–1946. doi: 10.1172/JCI104880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. SALVESEN H. A., BOE J. Osteomalacia in sprue. Acta Med Scand. 1953;146(4):290–299. doi: 10.1111/j.0954-6820.1953.tb10243.x. [DOI] [PubMed] [Google Scholar]
  21. Singer F. R., Woodhouse N. J., Parkinson D. K., Joplin G. F. Some acute effects of administered porcine calcitonin in man. Clin Sci. 1969 Aug;37(1):181–190. [PubMed] [Google Scholar]
  22. Stanbury S. W., Lumb G. A. Parathyroid function in chronic renal failure. A statistical survey of the plasma biochemistry in azotaemic renal osteodystrophy. Q J Med. 1966 Jan;35(137):1–23. [PubMed] [Google Scholar]
  23. TAITZ L. S., DE LACY C. D. Parathyroid function in vitamin D deficiency rickets. II. The relationship of parathyroid function to bone changes and incidence of tetany in vitamin D deficiency rickets in South African Bantu infants. Pediatrics. 1962 Dec;30:884–892. [PubMed] [Google Scholar]

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