Causes of elevated parathyroid hormone levels in postmenopausal women

Year 2017, Volume: 3 Issue: 3, 234 - 242, 04.11.2017

İrfan Esen , Selin Akturk Esen , Soner Cander , Ozen Oz Gul , Gokhan Ocakoglu , Erdinc Erturk

https://doi.org/10.18621/eurj.278518

Cited By: 1

Abstract

Objective. In this study we aimed to investigate causes of
hyperparathyroidism and related factors in postmenopausal women. Methods.
The study was conducted on 156 postmenopausal women, 43 with normal serum parathyroid
hormone (PTH) levels and 113 with elevated serum PTH levels. Serum levels of
25-OH vitamin D, calcium and phosphorus, 24-hour urine calcium, phosphorus and
calcium/creatinine ratio were compared between study groups. Also, bone mineral
density, age of menopause, educational level, occupation, clothing style,
daylight exposure time and daily dietary calcium consumption of subjects and
relationships of these parameters with parathyroid hormone levels were
investigated. Results. Causes
of elevated serum PTH level were vitamin D deficiency in 92.9% and primary
hyperparathyroidism in 4.4% of study group. Serum PTH levels were significantly
higher in housewives (p<0.001),
women with less than a high school graduates (p=0.008), and the veiled women (p=0.025).
Serum 25-OH vitamin D levels were significantly lower in the veiled covered (p=0.002) and participants with less than a high school graduate (p=0.041). Significant negative
correlation was detected between serum 25-OH vitamin D and the logarithmic
value of serum PTH levels (r= -0.188; p=0.019).
Conclusions. Vitamin D
deficiency was common in all postmenopausal women but especially in those with
lower education level and the veiled. Postmenopausal women should be screened
for vitamin D deficiency and encouraged to benefit more from sunlight. Also,
enriching foods in the markets with vitamin D may be helpful for decreasing
hyperparathyroidism in this population. 

Keywords

vitamin D deficiency, postmenopausal women, Primary hyperparathyroidism, secondary hyperparathyroidism, parathyroid hormome

References

• [1] Bolland MJ, Grey AB, Orr-Walker B, Home AM, Evans MC, Clearwater JM, et al. Prospective 10-year study of postmenopausal women with asymptomatic primary hyperparathyroidism. N Z Med J 2008;121:18-29.
• [2] Saleh F, Jorde R, Sundsfjord J, Haug E, Figenschau Y. Causes of secondary hyperparathyroidism in a healthy population: the Tromso study. J Bone Miner Metab 2006;24:58-64.
• [3] Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004;79:362-71.
• [4] Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2005; 3:227.
• [5] Albertazzi P, Steel SA, Purdie DW, Gurney E, Atkin SL, Robertson WS. Hyperparthyroidism in elderly osteopenic women. Maturitas 2002;43:245-9.
• [6] Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004;35:312-9.
• [7] Sahota O, Gaynor K, Harwood RH, Hosking DJ. Hypovitaminosis D and 'functional hypoparathyroidism'-the NoNoF (Nottingham Neck of Femur) study. Age Ageing 2001;30:467-72.
• [8] McKane PJM, Khosla S, Egan KS, Robins SP, Burritt MF, Riggs BL. Role of calcium intake in modulating agerelated increases in parathyroid function and bone resorption. J Clin Endocrinol Metab 1996;81:1699-703.
• [9] Cerrahoglu L, Duruoz MT, Tikiz C, Olcenler S, Tulukoglu N, Susin A. [The correlation between dietary calcium intake and bone mineral density in postmenopausal women]. Osteoporoz Dünyasından 2002;8:173-7. [Article in Turkish]
• [10] McKenna MJ, Freaney R. Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int 1998;8:3-6.
• [11] Rejnmark L, Vestergaard P, Brot C, Mosekilde L. Increased fracture risk in normocalcemic postmenopausal women with high parathyroid hormone levels: a 16-year follow-up study. Calcif Tissue Int 2011;88:238-45.
• [12] Nakamura K, Tsugawa N, Saito T, Ishikawa M, Tsuchiya Y, Hyodo K, et al. Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study. Bone 2008;42:271-7.
• [13] Bates CJ, Carter GD, Mishra GD, O'Shea D, Jones J, Prentice A. In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey. Osteoporos Int 2003;14:152-9.
• [14] Kaya T, Ulutas O, Celebiler Cavusoglu A, Aslanca D, Karateper AG, Gunaydin R, et.al. [Serum levels of 25 (0H) vitamin D and hyperparathyroidism in healthy postmenopausal women]. Romatizma 2007;22:20-3. [Article in Turkish]
• [15] Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, et al. Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 1989;4:283-91.
• [16] Khan A, Bilezikian J. Primary hyperparathyroidism: pathophysiology and impact on bone. JAMC 2000;163:184-7.
• [17] Seeman E, Wahner HW, Offord KP, Kumar R, Johnson WJ, Riggs BL. Differential effects of endocrine dysfunction on the axial and the appendicular skeleton. J Clin Invest 1982;69:1302-9.
• [18] McKenna MJ, Freaney R. Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int 1998;8:3-6.
• [19] Peacock M, Selby PL, Francis RM, Brown WB, Hordon L. Vitamin D deficiency, insufficiency, sufficiency and intoxication. What do they mean? In: Norman AW, Schaefer K, Grigoleit H-G, Herrath DV, editors. , eds. Vitamin D: Chemical, Biochemical and Clinical Update. Berlin, Germany: Walter de Gruyter; 1985:569-70.
• [20] Saliba W, Barnett O, Rennert HS, Lavi I, Rennert G. The relationship between serum 25(OH)D and parathyroid hormone levels. Am J Med 2011;124:1165-70.
• [21] Sai AJ, Walters RW, Fang X, Gallagher JC. Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 2011;96:436-46.
• [22] Silverberg SJ. Vitamin D deficiency and primary hyperparathyroidism. J Bone Miner Res 2007;22 Suppl 2:V100-2.
• [23] Gaugrıs S, Heaney R, Boonen S, Kurth H, Bentkover JD, Sen SS. Vitamin D inadequacy among post-menopausal women: a systematic review. QJM 2005;98:667-76.
• [24] Souberbielle JC, Friedlander G, Kahan A, Cormier C. Evaluating vitamin D status. Implications for preventing and managing osteoporosis and other chronic diseases. Joint Bone Spine 2006;73:249-53.
• [25] Basaran S, Guzel R, Benlidayi IC, Uysal FG. [Effects of vitamin D levels on quality of life in osteoporosis]. Osteoporoz Dünyasından 2006;12:35-8. [Article in Turkish]
• [26] Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF. Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 1992;75:1099-103.
• [26] Matsuoka LY, Wortsman J, Dannenberg MJ, et al. Clothing prevents ultraviolet-B radiationdependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 1992;75:1099-103.
• [27] Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int 2001;12:931-5.
• [28] Scharla SH. Prevalence of subclinical vitamin D deficiency in different European countries. Osteoporos Int 1998;8 Supp 2:S7-12.
• [29] MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985;76:1536-8.
• [30] Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 1989;2:1104-5.
• [31] Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KR, et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 2004:89:3152-7.
• [32] Zerwekh JE. The measurement of vitamin D: analytical aspects. Ann Clin Biochem 2004;41:272-81.
• [33] Snellman G, Melhus H, Gedeborg R, Byberg L, Berglund L, Wernroth L, et al. Determining vitamin D status: a comparison between commercially available assays. PLoS One 2010;5:e11555.
• [34] Adami S, Braga V, Squaranti R, Rossini M, Gatti D, Zamberlan N. Bone measurement in asymptomatic primary hyperparathyroidism. Bone 1998;22:565-70.