Vitamin D in Primary Hyperparathyroidism: Effects on Clinical, Biochemical, and Densitometric Presentation

Context: Vitamin D (25-hydroxyvitamin D [25OHD]) deficiency (< 20 ng/mL) and insufficiency (20-29 ng/mL) are common in primary hyperparathyroidism (PHPT), but data regarding their skeletal effects in PHPT are limited. Objective: The objective was to evaluate the association between 25OHD levels and PHPT severity. Design, Settings, and Participants: This is a cross-sectional analysis of 100 PHPT patients with and without 25OHD insufficiency and deficiency from a university hospital setting. Outcome Measures: We measured calciotropic hormones, bone turnover markers, and bone mineral density (BMD) by dual x-ray absorptiometry. Results: Lower 25 OHD was associated with some (PTH: r = - 0.42; P <.0001; 1,25-dihydroxyvitamin D: r = - 0.27; P =.008; serum PO4: r = 0.31; P =.002) but not all (serum/urine calcium) indicators of PHPT severity. Lower 25 OHD was also associated with younger age, higher body mass index, male gender, better renal function, and lower vitamin D intake. Comparison of those with deficient (< 20 ng/mL; 19%) vs insufficient (20-29 ng/mL; 35%) vs replete (>= 30 ng/mL; 46%) 25 OHD demonstrated more severe PHPT as reflected by higher PTH (mean +/- SEM, 126 +/- 10 vs 81 +/- 7 vs 72 +/- 7 pg/mL; P <.0001) but no difference in nephrolithiasis, osteoporosis, fractures, serum or urinary calcium, bone turnover markers, or BMD after adjustment for age and weight. In women, T-scores at the 1/3 radius were lower in those with 25OHD of 20-29 ng/mL, compared to those who were vitamin D replete (P =.048). In multiple regression modeling, 25OHD (but not PTH) was an independent predictor of 1/3 radius BMD. Conclusion: Vitamin D deficiency is associated with more severe PHPT as reflected by PTH levels, but effects on BMD are limited to the cortical 1/3 radius and are quite modest. These data support international guidelines that consider PHPT patients with 25OHD < 20 ng/mL to be deficient. However, in this cohort with few profoundly vitamin D-deficient patients, vitamin D status did not appear to significantly impact clinical presentation or bone density.