Effects of Elevated Parathyroid Hormone Levels on Muscle Health, Postural Stability and Quality of Life in Vitamin D-Insufficient Healthy Women: A Cross-Sectional Study

  • Lise Sofie BislevEmail author
  • Lene Langagergaard Rødbro
  • Tanja Sikjær
  • Lars Rejnmark
Original Research


Independently of plasma 25-hydroxyvitamin D (P-25(OH)D) levels, elevated parathyroid hormone (PTH) levels may exert an adverse effect on muscle health, postural stability, well-being, and quality of life. Using a cross-sectional design, we investigated 104 healthy postmenopausal women with low P-25(OH)D (< 50 nmol/l) levels, who had either secondary hyperparathyroidism (SHPT) with elevated PTH levels (> 6.9 pmol/l, n = 52) or normal PTH levels (n = 52). The average PTH value in women with SHPT was 8.5 (interquartile range 7.5–9.7) pmol/l and 5.3 (4.4–6.3) pmol/l in women with normal PTH (p < 0.001). Plasma phosphate was significantly lower in women with SHPT than in women with normal PTH (1.01 ± 0.14 vs. 1.09 ± 0.13 mmol/l; p < 0.01). In the total cohort, average level of 25(OH)D were 38 (31–45) nmol/l, with no differences between groups. SHPT was associated with impaired muscle strength as assessed by both maximum muscle strength and maximum force production at knee flexion with the knee fixed at 60° and 90° (pall < 0.05). Postural stability was impaired during semi tandem standing (p = 0.001). However, the two groups did not differ in terms of self-reported physical activity, muscle-related symptoms, quality of life, or lean muscle mass as assessed by dual-energy X-ray absorptiometry. Independently of 25(OH)D levels, mild to moderately elevated PTH levels are associated with adverse effects on muscle strength and postural stability. Why some individuals respond to vitamin D insufficiency with an elevated PTH and others do not need further elucidation, but elevated PTH itself seems to affect muscle function and postural stability.



We owe our greatest gratitude to all participants and the laboratory technicians at Aarhus University Hospital for astonishing commitment and goodwill.


The study was funded by Aarhus University, The Augustinus Foundation, The Foundation of Endocrinology Aarhus University Hospital, Toyota Foundation, A.P. Møller & wife Chastine MC-Kinney Møllers Foundation, and P. A. Messerschmidt & wife foundation.

Compliance with Ethical Standards

Conflict of interest

Lise Sofie Bislev, Lene Langagergaard Rødbro, Tanja Sikjaer, and Lars Rejnmark declare that they have no conflict of interest.

Ethical Approval

The study was conducted in accordance with the Helsinki II Declaration considering biomedical research. The study was approved by The Danish Data Protection Agency (1-16-02-492-14), the Regional Committee on Biomedical Research Ethics (1-10-72-326-14), The Danish Health Authority (2014-003645-10), and Danish Health Data Authority (FSEID-00001274). identifier: #NCT02572960.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed Consent

All participants provided an informed written consent prior to inclusion.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark

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