Calciotropic Hormones and the Prevalence of Vertebral Fractures in Chinese Postmenopausal Women with Vitamin D Insufficiency: Peking Vertebral Fracture Study
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This case–control study aimed to examine the effect of high serum parathyroid hormone (PTH) level, especially the effect of secondary hyperparathyroidism (SHPT) related to hypovitaminosis D, on bone metabolism and bone phenotypes. We included a total of 830 Chinese postmenopausal women aged ≥ 50 years with serum 25-hydroxyvitamin D (25(OH)D) level < 30 ng/ml, among whom 415 women had prevalent vertebral fractures (VFs) and others were age-matched controls. We measured serum levels of 25(OH)D, PTH and bone turnover markers (BTMs), which included C-terminal telopeptide of type I collagen (β-CTX), N-aminoterminal prepeptide of type I procollagen (P1NP) and osteocalcin (OC). Bone mineral densities (BMDs) at lumbar spine and femoral neck were quantified by dual-energy X-ray absorptiometry. Morphometric VFs were validated by lateral radiograph of thoracolumbar spine. Compared to fracture-free controls, women with VFs exhibited a higher serum level of PTH and a higher percentage of SHPT (both p < 0.05), but had a similar serum level of 25(OH)D (p = 0.166). Positive correlations were depicted between PTH and BTMs (all p < 0.01), and between 25(OH)D and bone formation markers (p = 0.013 for OC, p = 0.068 for P1NP), whereas no significant correlation was identified between both calciotropic hormones and BMDs or between 25(OH)D and β-CTX (all p > 0.05). Increasing PTH was associated with an increased risk of VFs independent of 25(OH)D and BMD [odds ratio (OR) per SD increase in PTH 1.016, 95% confidence interval (95% CI) 1.006–1.027]. Moreover, women with SHPT (i.e., > 68 pg/ml) had about three times odds for VF compared to women with normal PTH levels (OR 3.270, 95% CI 1.581–6.760). These data suggest that evaluated serum PTH level might promote the bone remodeling and then lead to increased risks of VFs among Chinese postmenopausal women with vitamin D insufficiency.
KeywordsVitamin D insufficiency Secondary hyperparathyroidism Bone turnover markers Bone mineral density Vertebral fractures Chinese postmenopausal women
Our deepest gratitude to all the study participants and to the participating centers of the original parent study: Department of Endocrinology, China Rehabilitation Research Center; Department of Endocrinology, Beijing Liangxiang Hospital; Department of Cadre Unit, General Hospital of the Second Artillery Force; Department of Endocrinology, Peking University Shougang Hospital; Department of Endocrinology, Beijing Chaoyang Hospital, Capital University of Medical Science; Department of Endocrinology, Beijing Haidian Hospital; Department of Geriatric Endocrinology, Chinese People’s Liberation Army, General Hospital. We would also like to thank Ms. Yingying Hu for her valuable work in testing biomarker. The Peking Vertebral Fracture Study (PK-VF) study was funded by the National Natural Science Foundation of China (Nos. 81070687 and 81170805), National Science and Technology Pillar Program (2006BAI02B03), National Science and Technology Major Projects for “Major New Drugs Innovation and Development” (Grant 2008ZX09312-016), Beijing Natural Science Foundation (No. 7121012), Scientific Research Foundation of Beijing Medical Development (No. 2007-3029) and National Key Program of Clinical Science (WBYZ2011-873).
Compliance with Ethical Standards
Conflict of interest
Ruizhi Jiajue, Yan Jiang, Xuan Qi, Qiuping Wang, Wenbo Wang, Yu Pei, Xiran Wang, Wei Huang, Xin Zheng, Zhiwei Ning, Ou Wang, Mei Li, Xiaoping Xing, Wei Yu, Ling Xu, and Weibo Xia declare that they don’t have conflicts of interest in this work.
Human and Animal Rights Statement
The study was approved by the Department of Scientific Research, the Ethics Committee in Peking Union Medical College Hospital (PUMCH).
All subjects agreed to participate in this study and signed informed consent forms.
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