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Journal of Endocrinological Investigation

, Volume 29, Issue 9, pp 809–813 | Cite as

High prevalence of secondary hyperparathyroidism due to hypovitaminosis D in hospitalized elderly with and without hip fracture

  • A. Giusti
  • A. Barone
  • M. Razzano
  • M. Pizzonia
  • M. Oliveri
  • E. Palummeri
  • G. Pioli
Original Articles

Abstract

Objectives: To determine and compare the prevalence of secondary hyperparathyroidism (HPTH) in a population of community-dwelling and institutionalized older adults hospitalized with and without hip fracture, and to evaluate factors correlated with secondary HPTH in this population. Methods: Circulating concentrations of serum intact PTH, 25-hydroxyvitamin D [25(OH)D] total serum calcium and albumin were measured in 160 subjects with an osteoporotic fracture of the proximal femur and in 160 matched controls hospitalized for a disease unrelated to bone status. Patients with secondary causes of bone loss and taking medications affecting bone metabolism were excluded. Age, sex, place of residence and the ability to perform basic activities of daily living (BADL) two weeks before hospital admission were recorded at baseline. Results: Patients were comparable with regard to the baseline demographic, biochemical and functional characteristics. The overall prevalence of secondary hyperparathyroidism was 51.2%, without significant differences between hip fractured patients and controls (50.6 vs 51.9%, p=0.911). In bivariate analysis only the age and functional status (BADL) demonstrated a significant relationship with secondary HPTH, while sex and place of residence were not significant. These results were also confirmed in multivariate analysis. Particularly, the risk of secondary HPTH increased with age and with the number of functions lost in BADL: patients fully dependent showed a 3 times as high risk (odd ratio 3.07, 95% confidence interval 1.73 to 5.46, p=0.000) compared to patients independent in BADL, and subject aged >88 yr had a twice as high risk of developing secondary HPTH compared to younger ones (odd ratio 2.28, 95% confidence interval 1.20 to 4.32, p=0.012). Conclusion: These results show that secondary HPTH due to hypovitaminosis D is a frequent disorder in hospitalized elderly, strongly correlated with the functional status, irrespective of sex and place of residence.

Key-words

Hip fracture elderly functional status secondary hyperparathyroidism vitamin D 

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References

  1. 1.
    Bruce DG, St John A, Nicklason F, Goldswain PRT. Secondary hyperparathyroidism in patients from Western Australia with hip fracture: relationship to type of hip fracture, renal function, and vitamin D deficiency. J Am Geriatr Soc 1999, 47: 354–9.PubMedGoogle Scholar
  2. 2.
    Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 2000, 85: 4125–30.PubMedGoogle Scholar
  3. 3.
    Chapuy MC, Schott AM, Garnero P, et al. Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 1996, 81: 1129–33.PubMedGoogle Scholar
  4. 4.
    Lips P, Duong T, Oleksik A, et al. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab 2001, 86: 1212–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S. Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors. Osteoporos Int 2003, 14: 577–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Mosekilde L. Vitamin D and the elderly. Clin Endocrinol (Oxf) 2005, 62: 265–81.CrossRefGoogle Scholar
  7. 7.
    Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures snd therapeutic implications. Endocr Rev 2001, 22: 477–501.PubMedCrossRefGoogle Scholar
  8. 8.
    Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD. Vitamin D and bone health in the elderly. Am J Clin Nutr 1982, 36: 1014–31.PubMedGoogle Scholar
  9. 9.
    Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997, 7: 439–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Guillemant J, Taupin P, Le HT, et al. Vitamin D status during puberty in French healthy male adolescents. Osteoporos Int 1999, 10: 222–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Jesudason D, Need AG, Horowitz M, O’Loughlin PD, Morris HA, Nordin BE. Relationship between serum 25-hydroxy-vitamin D and bone resorption markers in vitamin D insufficiency. Bone 2002, 31: 626–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963, 185: 914–9.Google Scholar
  13. 13.
    Inderjeeth CA, Nicklason F, Al-Lahham Y, et al. Vitamin D deficiency and secondary hyperparathyroidism: clinical and biochemical associations in older non-institutionalised Southern Tasmanians. Aust N Z J Med 2000, 30: 209–14.PubMedCrossRefGoogle Scholar
  14. 14.
    Compston JE, Silver AC, Croucher PI, Brown RC, Woodhead JS. Elevated serum intact parathyroid hormone levels in elderly patients with hip fracture. Clin Endocrinol (Oxf) 1989, 31: 667–72.CrossRefGoogle Scholar
  15. 15.
    Boonen S, Broos P, Verbeke G, et al. Calciotropic hormones and markers of bone remodeling in age-related (type II) femoral neck osteoporosis: alterations consistent with secondary hyperparathyroidism-induced bone resorption. J Gerontol A Biol Sci Med Sci 1997, 52: M286–93.PubMedCrossRefGoogle Scholar
  16. 16.
    LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 1999, 281: 1505–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Benhamou CL, Tourliere D, Gauvain JB, Picaper G, Audran M, Jallet P. Calciotropic hormones in elderly people with and without hip fracture. Osteoporos Int 1995, 5: 103–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Falch JA, Mowe M, Bohmer T, Haug E. Serum levels of intact parathyroid hormone in elderly patients with hip fracture living at home. Acta Endocrinol (Copenh) 1992, 126: 10–2.Google Scholar
  19. 19.
    Stevenson JC, Allen PR, Abeyasekera G, Hill PA. Osteoporosis with hip fracture: changes in calcium regulating hormones. Eur J Clin Invest 1986, 16: 357–60.PubMedCrossRefGoogle Scholar
  20. 20.
    MacDonald D, Lau E, Chan EL, et al. Serum intact parathyroid hormone levels in elderly Chinese females with hip fracture. Calcif Tissue Int 1992, 51: 412–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Ng K, St John A, Bruce DG. Secondary hyperparathyroidism, vitamin D deficiency and hip fracture: importance of sampling times after fracture. Bone Miner 1994, 25: 103–9.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  • A. Giusti
    • 1
  • A. Barone
    • 1
  • M. Razzano
    • 1
  • M. Pizzonia
    • 1
  • M. Oliveri
    • 1
  • E. Palummeri
    • 1
  • G. Pioli
    • 1
  1. 1.Department of Gerontology and MusculoSkeletal SciencesE.O. Galliera HospitalGenovaItaly

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