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
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.
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). Clinicaltrials.gov identifier: #NCT02572960.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
All participants provided an informed written consent prior to inclusion.
- 7.Houston DK, Cesari M, Ferrucci L et al (2007) Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A 62:440–446. https://doi.org/10.1016/j.freeradbiomed.2008.10.025.The CrossRefGoogle Scholar
- 14.Ceglia L, Niramitmahapanya S, da Silva Morais M et al (2013) A randomized study on the effect of vitamin D3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98:E1927–E1935. https://doi.org/10.1210/jc.2013-2820 CrossRefGoogle Scholar
- 17.Kedes L, Massry SG (1993) Parathyroid hormone-parathyroid hormone related protein receptor messenger RNA is present in many tissues besides the kidney. Am J Nephrol 90033:210–213Google Scholar
- 29.Bislev LS, Langagergaard Rødbro L, Rolighed L et al (2018) Effects of vitamin D3 supplementation on muscle strength, mass, and physical performance in women with vitamin D insufficiency: a randomized placebo-controlled trial. Calcif Tissue Int. https://doi.org/10.1007/s00223-018-0443-z Google Scholar
- 31.Hermann AP, Thomsen J, Vestergaard P et al (1999) Assessment of calcium intake. A quick method comparerd to a 7 days food diary. Calcif Tissue Int 64:82Google Scholar
- 35.Aadahl M, Jørgensen T (2003) Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 35:1196–1202. https://doi.org/10.1249/01.MSS.0000074446.02192.14 CrossRefGoogle Scholar
- 46.Rolighed L, Rejnmark L, Sikjaer T et al (2015) No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial. Eur J Endocrinol 172:609–617. https://doi.org/10.1530/EJE-14-0940 CrossRefGoogle Scholar