Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: a meta-analysis and review of literature

Context The safety of vitamin D replacement in subjects with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency is not well established. Objective To evaluate the safety of vitamin D replacement in PHPT. Data Source Data were searched from Medline, EMBASE, Cochrane CENTRAL and abstracts form annual scientific meetings of various international bone and mineral societies. Study Selection Studies examining the effect of preoperative vitamin D replacement in patients with PHPT and coexisting vitamin D deficiency, irrespective of year and language of the publication were included in the present meta-analysis. Data Extraction Data were extracted from text of the included publications or abstract of conferences. Data Synthesis Ten studies enrolling 340 subjects with PHPT were analysed in this meta-analysis. After vitamin D replacement, there was significant increase in 25(OH) D levels by 55 center dot 3nmol/l (95% CI 33 center dot 3-77 center dot 3), reduction in serum parathyroid hormone levels by 3 center dot 5 pmol/l (5 center dot 8 to -1 center dot 2) without change in serum calcium (-0 center dot 08mmol/l, -0 center dot 2 to +0 center dot 03) and urinary calcium levels (0 center dot 72mmol/24h, P=0 center dot 2) compared to baseline. Conclusion Vitamin D replacement in subjects with PHPT and coexistent vitamin D deficiency increase 25 (OH) D and reduce serum PTH significantly without causing hypercalcaemia and hypercalciuria. The finding of the study needs to be confirmed by a large randomized trial in patient with PHPT and coexistent vitamin D deficiency.