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01-12-2019 | Hyperparathyroidism | Original Research

Effects of Elevated Parathyroid Hormone Levels on Muscle Health, Postural Stability and Quality of Life in Vitamin D-Insufficient Healthy Women: A Cross-Sectional Study

Authors: Lise Sofie Bislev, Lene Langagergaard Rødbro, Tanja Sikjær, Lars Rejnmark

Published in: Calcified Tissue International | Issue 6/2019

Abstract

Independently of plasma 25-hydroxyvitamin D (P-25(OH)D) levels, elevated parathyroid hormone (PTH) levels may exert an adverse effect on muscle health, postural stability, well-being, and quality of life. Using a cross-sectional design, we investigated 104 healthy postmenopausal women with low P-25(OH)D (< 50 nmol/l) levels, who had either secondary hyperparathyroidism (SHPT) with elevated PTH levels (> 6.9 pmol/l, n = 52) or normal PTH levels (n = 52). The average PTH value in women with SHPT was 8.5 (interquartile range 7.5–9.7) pmol/l and 5.3 (4.4–6.3) pmol/l in women with normal PTH (p < 0.001). Plasma phosphate was significantly lower in women with SHPT than in women with normal PTH (1.01 ± 0.14 vs. 1.09 ± 0.13 mmol/l; p < 0.01). In the total cohort, average level of 25(OH)D were 38 (31–45) nmol/l, with no differences between groups. SHPT was associated with impaired muscle strength as assessed by both maximum muscle strength and maximum force production at knee flexion with the knee fixed at 60° and 90° (p_all < 0.05). Postural stability was impaired during semi tandem standing (p = 0.001). However, the two groups did not differ in terms of self-reported physical activity, muscle-related symptoms, quality of life, or lean muscle mass as assessed by dual-energy X-ray absorptiometry. Independently of 25(OH)D levels, mild to moderately elevated PTH levels are associated with adverse effects on muscle strength and postural stability. Why some individuals respond to vitamin D insufficiency with an elevated PTH and others do not need further elucidation, but elevated PTH itself seems to affect muscle function and postural stability.

Young A, Brenton DP, Edwards RHT (1978) Analysis of muscle weakness in osteomalacia. Clin Sci 54:31CrossRef

Russell JA (1994) Osteomalacic myopathy. Muscle Nerve 17:578–580. https://doi.org/10.1002/mus.880170603 CrossRefPubMed

Al-Shoha A, Qiu S, Palnitkar S, Rao DS (2009) Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocr Pract 15:528–533. https://doi.org/10.4158/EP09050.ORR CrossRefPubMed

Bischoff-Ferrari HA, Conzelmann M, Stähelin HB et al (2006) Is fall prevention by vitamin D mediated by a change in postural or dynamic balance? Osteoporos Int 17:656–663. https://doi.org/10.1007/s00198-005-0030-9 CrossRefPubMed

Bischoff-ferrari HA, Giovannucci E, Willett WC et al (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28CrossRef

Wicherts IS, Van Schoor NM, Boeke AJP et al (2007) Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92:2058–2065. https://doi.org/10.1210/jc.2006-1525 CrossRefPubMed

Houston DK, Cesari M, Ferrucci L et al (2007) Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A 62:440–446. https://doi.org/10.1016/j.freeradbiomed.2008.10.025.The CrossRef

Dretakis OE, Tsatsanis C, Fyrgadis A et al (2010) Correlation between serum 25-hydroxyvitamin D levels and quadriceps muscle strength in elderly cretans. J Int Med Res 38:1824–1834. https://doi.org/10.1177/147323001003800530 CrossRefPubMed

Mastaglia SR, Seijo M, Muzio D et al (2011) Effect of vitamin D nutritional status on muscle function and strength in healthy women aged over sixty-five years. J Nutr Heal Aging 15:349–354. https://doi.org/10.1007/s12603-010-0287-3 CrossRef

10.

Boersma D, Demontiero O, Amiri ZM et al (2012) Vitamin D status in relation to postural stability. J Nutr 16:1–6. https://doi.org/10.1007/s12603-011-0345-5 CrossRef

11.

Dam T-TL, von Mühlen D, Barrett-Connor EL (2009) Sex-specific association of serum vitamin D levels with physical function in older adults. Osteoporos Int 20:751–760. https://doi.org/10.1007/s00198-008-0749-1 CrossRefPubMed

12.

Hoffmann MR, Senior PA, Mager DR (2015) Vitamin D supplementation and health-related quality of life: a systematic review of the literature. J Acad Nutr Diet 115:406–418. https://doi.org/10.1016/j.jand.2014.10.023 CrossRefPubMed

13.

Girgis CM, Mokbel N, Cha KM et al (2014) The vitamin D receptor (VDR) is expressed in skeletal muscle of male mice and modulates 25-hydroxyvitamin D (25OHD) uptake in myofibers. Endocrinology 155:3227–3237. https://doi.org/10.1210/en.2014-1016 CrossRefPubMedPubMedCentral

14.

Ceglia L, Niramitmahapanya S, da Silva Morais M et al (2013) A randomized study on the effect of vitamin D₃ supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98:E1927–E1935. https://doi.org/10.1210/jc.2013-2820 CrossRefPubMedPubMedCentral

15.

Eyles DW, Smith S, Kinobe R et al (2005) Distribution of the Vitamin D receptor and 1 a -hydroxylase in human brain. JMDC 29:21–30. https://doi.org/10.1016/j.jchemneu.2004.08.006 CrossRef

16.

Garcion E, Wion-barbot N, Montero-menei CN et al (2002) New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab 13:100–105CrossRef

17.

Kedes L, Massry SG (1993) Parathyroid hormone-parathyroid hormone related protein receptor messenger RNA is present in many tissues besides the kidney. Am J Nephrol 90033:210–213

18.

Stein M, Wark J, Scherer S et al (1999) Falls relate to vitamin D and parathyroid hormone in an australian nursing home and hostel. J Am Geriatr Soc 47:1195–1201CrossRef

19.

Genaro PS, Pinheiro MM, Szejnfeld VL, Martini LA (2015) Secondary hyperparathyroidism and its relationship with sarcopenia in elderly women. Arch Gerontol Geriatr 60:349–353. https://doi.org/10.1016/j.archger.2015.01.005 CrossRef

20.

Pfeifer M, Begerow B, Minne HW et al (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15:1113–1118. https://doi.org/10.1359/jbmr.2000.15.6.1113 CrossRefPubMed

21.

Bird ML, El Haber N, Batchelor F et al (2018) Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women. Gait Posture 59:71–75. https://doi.org/10.1016/j.gaitpost.2017.09.036 CrossRefPubMed

22.

Sambrook PN, Chen JS, March LM et al (2004) Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. J Clin Endocrinol Metab 89:1572–1576. https://doi.org/10.1210/jc.2003-031782 CrossRefPubMed

23.

Rolighed L, Amstrup AK, Jakobsen NFB et al (2014) Muscle function is impaired in patients with “asymptomatic” primary hyperparathyroidism. World J Surg 38:549–557. https://doi.org/10.1007/s00268-013-2273-5 CrossRefPubMed

24.

Rejnmark L, Vestergaard P, Brot C, Mosekilde L (2008) Parathyroid response to vitamin D insufficiency: relations to bone, body composition and to lifestyle characteristics. Clin Endocrinol (Oxf) 69:29–35. https://doi.org/10.1111/j.1365-2265.2008.03186.x CrossRef

25.

Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss. Endocr Rev 22:477–501. https://doi.org/10.1210/er.22.4.477 CrossRefPubMed

26.

Kannan S, Mahadevan S, Velayutham P et al (2014) Estimation of magnesium in patients with functional hypoparathyroidism. Indian J Endocrinol Metab 18:821–825. https://doi.org/10.4103/2230-8210.141365 CrossRefPubMedPubMedCentral

27.

Bislev LS, Langagergaard Rødbro L, Nørgaard Bech J et al (2018) Effects of treatment with an angiotensin 2 receptor blocker and/or vitamin D3 on parathyroid hormone and aldosterone: a randomized, placebo-controlled trial. Clin Endocrinol (Oxf). https://doi.org/10.1111/cen.13734 CrossRef

28.

Bislev LS, Langagergaard Rødbro L, Bech JN et al (2018) The effect of vitamin D3 supplementation on markers of cardiovascular health in hyperparathyroid, vitamin D insufficient women: a randomized placebo-controlled trial. Endocrine. https://doi.org/10.1007/s12020-018-1659-4 CrossRefPubMed

29.

Bislev LS, Langagergaard Rødbro L, Rolighed L et al (2018) Effects of vitamin D3 supplementation on muscle strength, mass, and physical performance in women with vitamin D insufficiency: a randomized placebo-controlled trial. Calcif Tissue Int. https://doi.org/10.1007/s00223-018-0443-z CrossRefPubMed

30.

Bislev LS, Langagergaard Rødbro L, Rolighed L et al (2018) Bone microstructure in response to vitamin D3 supplementation: a randomized placebo-controlled trial. Calcif Tissue Int. https://doi.org/10.1007/s00223-018-0481-6 CrossRefPubMed

31.

Hermann AP, Thomsen J, Vestergaard P et al (1999) Assessment of calcium intake. A quick method comparerd to a 7 days food diary. Calcif Tissue Int 64:82

32.

Curb JD, Ceria-Ulep CD, Rodriguez BL et al (2006) Performance-based measures of physical function for high-function populations. J Am Geriatr Soc 54:737–742. https://doi.org/10.1111/j.1532-5415.2006.00700.x CrossRefPubMed

33.

Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRef

34.

Annuzzi-Sucich M, Prestwood KM, Kenny AM (2002) Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A 57:M772–M777CrossRef

35.

Aadahl M, Jørgensen T (2003) Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 35:1196–1202. https://doi.org/10.1249/01.MSS.0000074446.02192.14 CrossRefPubMed

36.

Bjorner JB, Thunedborg K, Kristensen TS et al (1998) The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 51:991–999CrossRef

37.

Topp CW, Østergaard SD, Søndergaard S, Bech P (2015) The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 84:167–176. https://doi.org/10.1159/000376585 CrossRefPubMed

38.

Webb SM, Puig-Domingo M, Villabona C et al (2013) Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism. Health Qual Life Outcomes 11:1–8. https://doi.org/10.1186/1477-7525-11-97 CrossRef

39.

Webb SM, Villabona C, Marazuela M et al (2016) Validation of PHPQoL, a disease-specific quality-of-life questionnaire for patients with primary hyperparathyroidism. J Clin Endocrinol Metab 101:1571–1578. https://doi.org/10.1210/jc.2015-3094 CrossRefPubMed

40.

Roth HJ, Schmidt-Gayk H, Weber H et al (2008) Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography-tandem mass spectrometry as a reference. Ann Clin Biochem 45:153–159. https://doi.org/10.1258/acb.2007.007091 CrossRefPubMed

41.

Rødbro LL, Bislev LS, Sikjær T et al (2018) Bone metabolism, density, and geometry in postmenopausal women with vitamin D insufficiency: a cross-sectional comparison of the effects of elevated parathyroid levels. Osteoporos Int. https://doi.org/10.1007/s00198-018-4602-x CrossRefPubMed

42.

Glerup H, Mikkelsen K, Poulsen L et al (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66:419–424CrossRef

43.

Lips P, Cashman KD, Lamberg-Allardt C et al (2019) Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. https://doi.org/10.1530/eje-18-0736 CrossRefPubMed

44.

Bouillon R (2017) Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 13:466–479. https://doi.org/10.1038/nrendo.2017.31 CrossRefPubMed

45.

Reid IR (2018) High-dose vitamin D: without benefit but not without risk. J Intern Med. https://doi.org/10.1111/joim.12836 CrossRefPubMed

46.

Rolighed L, Rejnmark L, Sikjaer T et al (2015) No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial. Eur J Endocrinol 172:609–617. https://doi.org/10.1530/EJE-14-0940 CrossRefPubMed

47.

Blaine J, Chonchol M, Levi M (2015) Renal control of calcium, phosphate, and magnesium. Clin J Am Soc Nephrol 10:1257–1272. https://doi.org/10.2215/CJN.09750913 CrossRefPubMed

Title: Effects of Elevated Parathyroid Hormone Levels on Muscle Health, Postural Stability and Quality of Life in Vitamin D-Insufficient Healthy Women: A Cross-Sectional Study
Authors: Lise Sofie Bislev
Lene Langagergaard Rødbro
Tanja Sikjær
Lars Rejnmark
Publication date: 01-12-2019
Publisher: Springer US
Keyword: Hyperparathyroidism
Published in: Calcified Tissue International / Issue 6/2019
Print ISSN: 0171-967X
Electronic ISSN: 1432-0827
DOI: https://doi.org/10.1007/s00223-019-00612-2

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