M. K. Garg and N. Tandon are joint first authors.
The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population
Article first published online: 20 JUN 2013
© 2013 John Wiley & Sons Ltd
Volume 80, Issue 1, pages 41–46, January 2014
How to Cite
Garg, M. K., Tandon, N., Marwaha, R. K., Menon, A. S. and Mahalle, N. (2014), The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clinical Endocrinology, 80: 41–46. doi: 10.1111/cen.12248
- Issue published online: 5 DEC 2013
- Article first published online: 20 JUN 2013
- Accepted manuscript online: 18 MAY 2013 10:36AM EST
- Manuscript Accepted: 14 MAY 2013
- Manuscript Revised: 6 MAY 2013
- Manuscript Revised: 23 APR 2013
- Manuscript Received: 23 MAR 2013
- Defence Research and Development Organization (DRDO). Grant Number: INM305
- Ministry of Defence
Vitamin D deficiency (VDD) is a global problem. Not all patients with VDD have clinical manifestations or secondary hyperparathyroidism. We studied the interaction between serum 25-hydroxy vitamin D (25OHD), parathormone (PTH) and bone mineral density (BMD) in Indian adolescents and adults.
A total of 1829 adolescents and 1346 adults aged 50 years and above were analysed in this study.
Serum biochemistry, 25OHD, PTH and BMD were estimated. Subjects were grouped according to quartiles of serum PTH. VDD was defined as severe (25OHD ≤ 5 ng/ml), moderate (25OHD ≤ 10 ng/ml) and mild (25OHD ≤ 20 ng/ml) and secondary hyperparathyroidism (SHPT) when serum PTH levels >65 pg/ml.
Only 30–40% of subjects with moderate and severe VDD, respectively, had SHPT. BMD decreased from Quartile 1 to Quartile 4 of PTH at all sites among adolescents and adults, with only a marginal decline in serum 25OHD levels between these quartiles. Further, within each PTH quartile, there was no difference in BMD according to categories of VDD. Analysing BMD in the different PTH quartiles, the PTH cut-offs beyond which BMD showed a significant decline, was 35 pg/ml in adolescents and 53 pg/ml in adults.
Less than half of the subjects with VDD have SHPT. BMD levels start to decline at PTH values currently considered to be normal. These data suggest the need to redefine SHPT in different age groups keeping in mind the relationship between PTH and BMD. This may also influence the decision to supplement subjects with VDD.