Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1992 Aug 1;305(6848):273–277. doi: 10.1136/bmj.305.6848.273

Bone density parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women.

K T Khaw 1, M J Sneyd 1, J Compston 1
PMCID: PMC1882724  PMID: 1392857

Abstract

OBJECTIVE--To examine the relation between bone density and indices of calcium metabolism including parathyroid hormone and 25-hydroxyvitamin D concentrations in middle aged women. DESIGN--A cross sectional study. SETTING AND SUBJECTS--138 women volunteers aged 45-65 with no known osteoporosis and unselected for disease status recruited for a dietary assessment study from the community using general practice registers. Volunteer rate was 20%. MAIN OUTCOME MEASURE--Bone mineral density measured with dual energy x ray absorptiometry. RESULTS--Bone density at the lumbar spine and neck and trochanteric regions of the femur was inversely related to serum intact parathyroid hormone concentrations and positively related to serum 25-hydroxyvitamin D concentrations. These associations were independent of possible confounding factors, including age, body mass index, cigarette smoking habit, menopausal status, and use of diuretics and postmenopausal hormone replacement therapy. These associations were apparent throughout the whole distribution of bone density and 25-hydroxyvitamin D and parathyroid hormone concentrations within the normal range, suggesting a physiological relation. CONCLUSIONS--The findings are consistent with the hypothesis that parathyroid hormone and 25-hydroxyvitamin D concentrations influence bone density in middle aged women. Findings from this study together with other work suggest that the role of vitamin D in osteoporosis should not be neglected. The associations with parathyroid hormone also indicate plausible biological mechanisms. The roughly 5-10% difference in bone density between top and bottom tertiles of serum 25-hydroxyvitamin D concentrations, though not large in magnitude, may have considerable public health implications in terms of prevention of osteoporosis and its sequelae, fractures.

Full text

PDF
273

Selected References

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

  1. Aitken J. M., Anderson J. B., Horton P. W. Seasonal variations in bone mineral content after the menopause. Nature. 1973 Jan 5;241(5384):59–60. doi: 10.1038/241059a0. [DOI] [PubMed] [Google Scholar]
  2. Aloia J. F., Vaswani A., Yeh J. K., Ellis K., Yasumura S., Cohn S. H. Calcitriol in the treatment of postmenopausal osteoporosis. Am J Med. 1988 Mar;84(3 Pt 1):401–408. doi: 10.1016/0002-9343(88)90259-8. [DOI] [PubMed] [Google Scholar]
  3. Baker M. R., McDonnell H., Peacock M., Nordin B. E. Plasma 25-hydroxy vitamin D concentrations in patients with fractures of the femoral neck. Br Med J. 1979 Mar 3;1(6163):589–589. doi: 10.1136/bmj.1.6163.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boyce W. J., Vessey M. P. Rising incidence of fracture of the proximal femur. Lancet. 1985 Jan 19;1(8421):150–151. doi: 10.1016/s0140-6736(85)91915-4. [DOI] [PubMed] [Google Scholar]
  5. Calvo M. S., Eastell R., Offord K. P., Bergstralh E. J., Burritt M. F. Circadian variation in ionized calcium and intact parathyroid hormone: evidence for sex differences in calcium homeostasis. J Clin Endocrinol Metab. 1991 Jan;72(1):69–76. doi: 10.1210/jcem-72-1-69. [DOI] [PubMed] [Google Scholar]
  6. Calvo M. S., Kumar R., Heath H. Persistently elevated parathyroid hormone secretion and action in young women after four weeks of ingesting high phosphorus, low calcium diets. J Clin Endocrinol Metab. 1990 May;70(5):1334–1340. doi: 10.1210/jcem-70-5-1334. [DOI] [PubMed] [Google Scholar]
  7. Cummings S. R., Black D. M., Nevitt M. C., Browner W. S., Cauley J. A., Genant H. K., Mascioli S. R., Scott J. C., Seeley D. G., Steiger P. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA. 1990 Feb 2;263(5):665–668. [PubMed] [Google Scholar]
  8. Cummings S. R., Kelsey J. L., Nevitt M. C., O'Dowd K. J. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208. doi: 10.1093/oxfordjournals.epirev.a036281. [DOI] [PubMed] [Google Scholar]
  9. Frame B., Parfitt A. M. Osteomalacia: current concepts. Ann Intern Med. 1978 Dec;89(6):966–982. doi: 10.7326/0003-4819-89-6-966. [DOI] [PubMed] [Google Scholar]
  10. Gallagher J. C., Riggs B. L., Recker R. R., Goldgar D. The effect of calcitriol on patients with postmenopausal osteoporosis with special reference to fracture frequency. Proc Soc Exp Biol Med. 1989 Jul;191(3):287–292. doi: 10.3181/00379727-191-42922. [DOI] [PubMed] [Google Scholar]
  11. Gloth F. M., 3rd, Tobin J. D., Sherman S. S., Hollis B. W. Is the recommended daily allowance for vitamin D too low for the homebound elderly? J Am Geriatr Soc. 1991 Feb;39(2):137–141. doi: 10.1111/j.1532-5415.1991.tb01615.x. [DOI] [PubMed] [Google Scholar]
  12. Holbrook T. L., Barrett-Connor E., Wingard D. L. Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet. 1988 Nov 5;2(8619):1046–1049. doi: 10.1016/s0140-6736(88)90065-7. [DOI] [PubMed] [Google Scholar]
  13. Holick M. F. The photobiology of vitamin D and its consequences for humans. Ann N Y Acad Sci. 1985;453:1–13. doi: 10.1111/j.1749-6632.1985.tb11793.x. [DOI] [PubMed] [Google Scholar]
  14. Hui S. L., Slemenda C. W., Johnston C. C., Jr Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. 1988 Jun;81(6):1804–1809. doi: 10.1172/JCI113523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Jacobsen S. J., Goldberg J., Miles T. P., Brody J. A., Stiers W., Rimm A. A. Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987. Am J Epidemiol. 1991 May 15;133(10):996–1004. doi: 10.1093/oxfordjournals.aje.a115819. [DOI] [PubMed] [Google Scholar]
  16. Krall E. A., Sahyoun N., Tannenbaum S., Dallal G. E., Dawson-Hughes B. Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med. 1989 Dec 28;321(26):1777–1783. doi: 10.1056/NEJM198912283212602. [DOI] [PubMed] [Google Scholar]
  17. Lau E., Donnan S., Barker D. J., Cooper C. Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. BMJ. 1988 Dec 3;297(6661):1441–1443. doi: 10.1136/bmj.297.6661.1441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Law M. R., Wald N. J., Meade T. W. Strategies for prevention of osteoporosis and hip fracture. BMJ. 1991 Aug 24;303(6800):453–459. doi: 10.1136/bmj.303.6800.453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lindall A. W., Elting J., Ells J., Roos B. A. Estimation of biologically active intact parathyroid hormone in normal and hyperparathyroid sera by sequential N-terminal immunoextraction and midregion radioimmunoassay. J Clin Endocrinol Metab. 1983 Nov;57(5):1007–1014. doi: 10.1210/jcem-57-5-1007. [DOI] [PubMed] [Google Scholar]
  20. Lips P., Wiersinga A., van Ginkel F. C., Jongen M. J., Netelenbos J. C., Hackeng W. H., Delmas P. D., van der Vijgh W. J. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab. 1988 Oct;67(4):644–650. doi: 10.1210/jcem-67-4-644. [DOI] [PubMed] [Google Scholar]
  21. Lips P., van Ginkel F. C., Jongen M. J., Rubertus F., van der Vijgh W. J., Netelenbos J. C. Determinants of vitamin D status in patients with hip fracture and in elderly control subjects. Am J Clin Nutr. 1987 Dec;46(6):1005–1010. doi: 10.1093/ajcn/46.6.1005. [DOI] [PubMed] [Google Scholar]
  22. Lund B., Sorensen O. H., Christensen A. B. 25-Hydroxycholecaliferol and fractures of the proximal. Lancet. 1975 Aug 16;2(7929):300–302. doi: 10.1016/s0140-6736(75)92732-4. [DOI] [PubMed] [Google Scholar]
  23. Mazess R. B., Barden H. S. Bone densitometry for diagnosis and monitoring osteoporosis. Proc Soc Exp Biol Med. 1989 Jul;191(3):261–271. doi: 10.3181/00379727-191-42918. [DOI] [PubMed] [Google Scholar]
  24. Ott S. M., Chesnut C. H., 3rd Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med. 1989 Feb 15;110(4):267–274. doi: 10.7326/0003-4819-110-4-267. [DOI] [PubMed] [Google Scholar]
  25. Parfitt A. M., Gallagher J. C., Heaney R. P., Johnston C. C., Neer R., Whedon G. D. Vitamin D and bone health in the elderly. Am J Clin Nutr. 1982 Nov;36(5 Suppl):1014–1031. doi: 10.1093/ajcn/36.5.1014. [DOI] [PubMed] [Google Scholar]
  26. Parfitt A. M. Use of calciferol and its metabolites and analogues in osteoporosis. Current status. Drugs. 1988 Nov;36(5):513–520. doi: 10.2165/00003495-198836050-00001. [DOI] [PubMed] [Google Scholar]
  27. Preece M. A., O'Riordan J. L., Lawson D. E., Kodicek E. A competitive protein-binding assay for 25-hydroxycholecalciferol and 25-hydroxyergocalciferol in serum. Clin Chim Acta. 1974 Jul 31;54(2):235–242. doi: 10.1016/0009-8981(74)90241-1. [DOI] [PubMed] [Google Scholar]
  28. Raisz L. G. Local and systemic factors in the pathogenesis of osteoporosis. N Engl J Med. 1988 Mar 31;318(13):818–828. doi: 10.1056/NEJM198803313181305. [DOI] [PubMed] [Google Scholar]
  29. Riggs B. L., Melton L. J., 3rd Evidence for two distinct syndromes of involutional osteoporosis. Am J Med. 1983 Dec;75(6):899–901. doi: 10.1016/0002-9343(83)90860-4. [DOI] [PubMed] [Google Scholar]
  30. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1847–1851. doi: 10.1136/bmj.282.6279.1847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Silverberg S. J., Shane E., de la Cruz L., Segre G. V., Clemens T. L., Bilezikian J. P. Abnormalities in parathyroid hormone secretion and 1,25-dihydroxyvitamin D3 formation in women with osteoporosis. N Engl J Med. 1989 Feb 2;320(5):277–281. doi: 10.1056/NEJM198902023200503. [DOI] [PubMed] [Google Scholar]
  32. Tsai K. S., Ebeling P. R., Riggs B. L. Bone responsiveness to parathyroid hormone in normal and osteoporotic postmenopausal women. J Clin Endocrinol Metab. 1989 Nov;69(5):1024–1027. doi: 10.1210/jcem-69-5-1024. [DOI] [PubMed] [Google Scholar]
  33. Tsai K. S., Heath H., 3rd, Kumar R., Riggs B. L. Impaired vitamin D metabolism with aging in women. Possible role in pathogenesis of senile osteoporosis. J Clin Invest. 1984 Jun;73(6):1668–1672. doi: 10.1172/JCI111373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Villareal D. T., Civitelli R., Chines A., Avioli L. V. Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab. 1991 Mar;72(3):628–634. doi: 10.1210/jcem-72-3-628. [DOI] [PubMed] [Google Scholar]
  35. Wasnich R. D., Ross P. D., Heilbrun L. K., Vogel J. M. Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol. 1985 Dec 1;153(7):745–751. doi: 10.1016/0002-9378(85)90338-2. [DOI] [PubMed] [Google Scholar]
  36. Wickham C. A., Walsh K., Cooper C., Barker D. J., Margetts B. M., Morris J., Bruce S. A. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ. 1989 Oct 7;299(6704):889–892. doi: 10.1136/bmj.299.6704.889. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES