RELATIONSHIP BETWEEN VITAMIN D, CALCIUM, PARATHYROID HORMONE AND ALKALINE PHOSPHATASE AMONG PATIENTS INVESTIGATED FOR VITAMIN D
INTRODUCTION: Vitamin D deficiency causes rickets in young children and Osteomalacia in adults.
Parathyroid hormone (PTH) secretion, Calcium level and Alkaline phosphatase (ALP), elevated in cases of low level of VD. This study to detect the relationship between serum VD, (PTH), calcium and ALP. Serum 25OHD is regarded as the best indicator of VD status.
METHODS: The current study is a retrospective descriptive study in Azadi Teaching Hospital- Duhok Governorate – Kurdistan Region / Iraq. Out of 870 patients were included in the study. All VD requests were analysed, Calcium, ALP, PTH, and phosphate were recorded.
RESULTS: Fifty-nine percent of the requests were for females, and 27.9% of the included patients were receiving VD supplementation. The mean values for serum 25OHD and PTH levels were 34.5 nmol / L (13.8ng/ml) and 53.4pg / ml respectively.
Serum 25OHD was below 25 nmol / L in (227 / 870) 26.09 %, between 25 - 50 nmol / L in (391/ 870) 44.94%, and > 50 in (252 / 870) 28.96%.
Out of 227 patients with VD deficiency (< 25nmol / L), only 1(0.44%) had hypocalcaemia, 28 (12.33%) had abnormal high ALP, 109 (48%) had abnormal high PTH. Out of 252 patients with VD level > 50 nmol / L, 63 (25%) were found to have high PTH, 21 (8.33%) with high ALP, hypocalcaemia were found in 1(0.39%) and low phosphate were found in 7(2.77 %) of the patients.
Out of 391 patients with normal VD (< 25.1 -50 nmol / L), only 3 (0.76%) had hypocalcaemia, 30 (7.67%) had abnormal high ALP, and 154 (39.38%) had abnormal high PTH.
CONCLUSION: A normal Calcium level, ALP and/or PTH will not exclude 25OHD deficiency and measurement of 25OHD should be performed whenever VD deficiency is expected
Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J. IOF Committee of Scientific Advisors (CSA) Nutrition Working Group, Global vitamin D status and determinants of hypovitaminosis D. Osteoporos. Int. 2009; 20(11):1807–20.
van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract. Res. Clin. Endocrinol. Metab. 2011; 25(4):671–80.
Holick MF. Vitamin D deficiency. N Eng J Med 2007; 357 (3): 266-81.
World Health Organization Scientific Group on the Prevention and Management of Osteoporosis 2003 Prevention and management of osteoporosis: report of a WHO scientific group. Geneva: World Health Organization.
Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ,Vieth R 2005 Estimates of optimal vitaminDstatus. Osteoporos Int16:713–16.
Holick MF. VitaminDdeficiency.NEngl J Med 2007; 357:266–81.
Barth JH, Fiddy JB, Payne RB. Adjustment of serum total calcium for albumin concentration: effects of non-linearity and of regression differences between laboratories. Ann Clin Biochem. 1996; 33: 55-58.
Mawer EB, Hann TJ, Berry JL, Davies M. Vitamin D metabolism in patients intoxicated with ergocalciferol. Clinical science London England. 1979; 68: 135-41.
Consensus Vitamin D Position Statement [internet]. 2010; [cited 2012 May 08].
Sahota O, Mundey MK, San P, et al. The relationship between vitamin D andparathyroid hormones: calcium homeostasis, bone turnover, and bone mineral densityin postmenopausal women with established osteoporosis. Bone. 2004; 35:312–19.
Haarburger D, Hoffman M, Erasmus RT and Pillay TS. Relationship between vitamin D, calcium and parathyroid hormone in Cape Town. J Clin Pathol. 2009; 62: 567-69.
Hashemipour S, Larijani B, Adibi H et al. The status of biochemical parameters in varying degrees of vitamin D deficiency. J Bone Miner Metab. 2006; 24: 213-18.
Wang TJ, Zhang F, Richards JB et al. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet. 2010; 376: 180 - 88.
Peacey S. Routine Biochemistry in suspected vitamin D deficiency. J R Soc Med. 2004; 97: 322-25.
Das G, Crocombe S, McGrath M, Berry JL and Mughal MZ. Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 2006; 91: 569-72.
oxfordOxford Textbook of Endocrinology, Oxford University Press 2002. Editors John A. H. Wass and Stephen M. Shalet.
It is the policy of the Journal of Duhok University to own the copyright of the technical contributions. It publishes and facilitates the appropriate re-utilize of the published materials by others. Photocopying is permitted with credit and referring to the source for individuals use.
Copyright © 2017. All Rights Reserved.