Top

Osteoporosis International

Published in:

01-05-2016 | Original Article

Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density

Authors: M. Li, F. Lv, Z. Zhang, W. Deng, Y. Li, Z. Deng, Y. Jiang, O. Wang, X. Xing, L. Xu, W. Xia

Published in: Osteoporosis International | Issue 5/2016

Abstract

Summary

A normal reference value of parathyroid hormone (PTH) was established for the first time in a large sample of healthy Chinese subjects by completely excluding interference of vitamin D deficiency. A high PTH level correlated significantly with an elevated bone turnover and a reduced bone mineral density (BMD).

Introduction

The aims of this study are to establish a normal reference value for serum PTH and to evaluate the effect of parathyroid gland status on bone turnover and BMD.

Methods

Our cross-sectional study included 1436 healthy individuals from 5 different Chinese cities. Concentrations of serum PTH, 25-hydroxyvitamin D (25OHD), procollagen I N-terminal peptide (P1NP, a bone formation marker), and carboxyl-terminal telopeptide of type I collagen (β-CTX, a bone resorption marker) were measured by electrochemiluminescence immunoassay. BMD was measured by dual-energy X-ray absorptiometry. The relation of PTH concentration to age, gender, height, and weight was examined. Reference values of PTH were established for all subjects and for subjects categorized by serum 25OHD concentrations. Correlations of PTH levels with bone turnover biomarkers and BMD were statistically analyzed.

Results

Reference values of PTH were 8.84–69.95 pg/mL in all the subjects and 7.48–60.73 and 5.83–56.78 pg/mL in the subjects with serum 25OHD concentrations of ≥20 and ≥30 ng/mL, respectively. Serum PTH showed a negative linear correlation with 25OHD, and the breakpoint was 18.21 ng/mL, below which the PTH level rapidly increased. The increase in PTH levels with age showed a positive linear correlation with P1NP and β-CTX concentrations and a negative linear correlation with BMD at the lumbar spines and the femoral neck.

Conclusions

A reference value of PTH was established in a large sample of healthy Chinese subjects according to 25OHD status, gender, and age. A high PTH level correlated significantly with an elevated bone turnover and a reduced BMD.

Curtis JR, Ewing SK, Bauer DC, Cauley JA, Cawthon PM, Barrett-Connor E, Haney EM, Ishani A, Cremers S, Orwoll E (2012) Association of intact parathyroid hormone levels with subsequent hip BMD loss: the Osteoporotic Fractures in Men (MrOS) Study. J Clin Endocrinol Metab 97:1937–1944CrossRefPubMedPubMedCentral

Sai AJ, Walters RW, Fang X, Gallagher JC (2011) Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 96:E436–E446CrossRefPubMedPubMedCentral

Vignali E, Viccica G, Diacinti D et al (2009) Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 94:2306–2312CrossRefPubMedPubMedCentral

Li Y, Chen C, Liu HL, Qian G (2015) Vitamin d, parathyroid hormone, and heart failure in a Chinese elderly population. Endocr Pract 21:30–40CrossRefPubMed

Hagstrom E, Kilander L, Nylander R, Larsson EM, Michaelsson K, Melhus H, Ahlstrom H, Johansson L, Lind L, Arnlov J (2014) Plasma parathyroid hormone is associated with vascular dementia and cerebral hyperintensities in two community-based cohorts. J Clin Endocrinol Metab 99:4181–4189CrossRefPubMed

Hagstrom E, Hellman P, Larsson TE et al (2009) Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 119:2765–2771CrossRefPubMed

Rejnmark L, Vestergaard P, Heickendorff L, Mosekilde L (2011) Determinants of plasma PTH and their implication for defining a reference interval. Clin Endocrinol (Oxf) 74:37–43CrossRef

Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G (2010) Age but not gender modulates the relationship between PTH and vitamin D. Bone 47:408–412CrossRefPubMed

Gallagher JC, Peacock M, Yalamanchili V, Smith LM (2013) Effects of vitamin D supplementation in older African American women. J Clin Endocrinol Metab 98:1137–1146CrossRefPubMedPubMedCentral

10.

Joo NS, Dawson-Hughes B, Kim YS, Oh K, Yeum KJ (2013) Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010). J Bone Miner Res 28:764–770CrossRefPubMed

11.

Souberbielle JC, Friedlander G, Cormier C (2006) Practical considerations in PTH testing. Clin Chim Acta 366:81–89CrossRefPubMed

12.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine S (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930CrossRefPubMed

13.

Eastell R, Brandi ML, Costa AG, D’Amour P, Shoback DM, Thakker RV (2014) Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99:3570–3579CrossRefPubMed

14.

Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, Kanis JA (2011) International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med 49:1271–1274CrossRefPubMed

15.

Li M, Li Y, Deng W, Zhang Z, Deng Z, Hu Y, Xia W, Xu L (2014) Chinese bone turnover marker study: reference ranges for C-terminal telopeptide of type I collagen and procollagen I N-terminal peptide by age and gender. PLoS One 9:e103841CrossRefPubMedPubMedCentral

16.

Genant HK (1995) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 10:997–998CrossRefPubMed

17.

Hernandez JL, Olmos JM, Pariente E, Nan D, Martinez J, Llorca J, Valero C, Obregon E, Gonzalez-Macias J (2013) Influence of vitamin D status on vertebral fractures, bone mineral density, and bone turnover markers in normocalcemic postmenopausal women with high parathyroid hormone levels. J Clin Endocrinol Metab 98:1711–1717CrossRefPubMed

18.

Touvier M, Deschasaux M, Montourcy M et al (2014) Interpretation of plasma PTH concentrations according to 25OHD status, gender, age, weight status, and calcium intake: importance of the reference values. J Clin Endocrinol Metab 99:1196–1203CrossRefPubMed

19.

Aloia JF, Dhaliwal R, Shieh A, Mikhail M, Fazzari M, Ragolia L, Abrams SA (2014) Vitamin D supplementation increases calcium absorption without a threshold effect. Am J Clin Nutr 99:624–631CrossRefPubMed

20.

Jamali Z, Asadikaram G, Mahmoodi M, Sayadi A, Jamalizadeh A, Saleh-Moghadam M, Sirati-Sabt M, Arababadi MK (2013) Vitamin D status in female students and its relation to calcium metabolism markers, lifestyles, and polymorphism in vitamin D receptor. Clin Lab 59:407–413PubMed

21.

Shu L, Ji J, Zhu Q, Cao G, Karaplis A, Pollak MR, Brown E, Goltzman D, Miao D (2011) The calcium-sensing receptor mediates bone turnover induced by dietary calcium and parathyroid hormone in neonates. J Bone Miner Res 26:1057–1071CrossRefPubMedPubMedCentral

22.

Lin CH, Su CH, Hwang PP (2014) Calcium-sensing receptor mediates Ca(2+) homeostasis by modulating expression of PTH and stanniocalcin. Endocrinology 155:56–67CrossRefPubMed

23.

Need AG, O’Loughlin PD, Morris HA, Coates PS, Horowitz M, Nordin BE (2008) Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 23:1859–1863CrossRefPubMed

24.

Gallagher JC, Jindal PS, Smith LM (2014) Vitamin D does not increase calcium absorption in young women: a randomized clinical trial. J Bone Miner Res 29:1081–1087CrossRefPubMed

25.

Ritter CS, Brown AJ (2011) Direct suppression of PTH gene expression by the vitamin D prohormones doxercalciferol and calcidiol requires the vitamin D receptor. J Mol Endocrinol 46:63–66PubMed

26.

Ebeling PR (2014) Vitamin D and bone health: epidemiologic studies. Bonekey Rep 3:511CrossRefPubMedPubMedCentral

27.

Hu WW, Zhang Z, He JW, Fu WZ, Wang C, Zhang H, Yue H, Gu JM, Zhang ZL (2013) Establishing reference intervals for bone turnover markers in the healthy Shanghai population and the relationship with bone mineral density in postmenopausal women. Int J Endocrinol 2013:513925PubMedPubMedCentral

28.

Zhao J, Xia W, Nie M et al (2011) The levels of bone turnover markers in Chinese postmenopausal women: Peking Vertebral Fracture study. Menopause 18:1237–1243CrossRefPubMed

29.

Souberbielle JC, Fayol V, Sault C, Lawson-Body E, Kahan A, Cormier C (2005) Assay-specific decision limits for two new automated parathyroid hormone and 25-hydroxyvitamin D assays. Clin Chem 51:395–400CrossRefPubMed

30.

Souberbielle JC, Cormier C, Kindermans C, Gao P, Cantor T, Forette F, Baulieu EE (2001) Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 86:3086–3090PubMed

31.

Fuleihan Gel H, Bouillon R, Clarke B, Chakhtoura M, Cooper C, McClung M, Singh RJ (2015) Serum 25-hydroxyvitamin D levels: variability, knowledge gaps, and the concept of a desirable range. J Bone Miner Res 30:1119–1133CrossRef

32.

Metzger M, Houillier P, Gauci C et al (2013) Relation between circulating levels of 25(OH) vitamin D and parathyroid hormone in chronic kidney disease: quest for a threshold. J Clin Endocrinol Metab 98:2922–2928CrossRefPubMed

33.

Aloia JF, Talwar SA, Pollack S, Feuerman M, Yeh JK (2006) Optimal vitamin D status and serum parathyroid hormone concentrations in African American women. Am J Clin Nutr 84:602–609PubMedPubMedCentral

34.

Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58CrossRefPubMedPubMedCentral

35.

Lips P, van Schoor NM, de Jongh RT (2014) Diet, sun, and lifestyle as determinants of vitamin D status. Ann N Y Acad Sci 1317:92–98CrossRefPubMed

36.

Valcour A, Blocki F, Hawkins DM, Rao SD (2012) Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J Clin Endocrinol Metab 97:3989–3995CrossRefPubMed

37.

Valina-Toth AL, Lai Z, Yoo W, Abou-Samra A, Gadegbeku CA, Flack JM (2010) Relationship of vitamin D and parathyroid hormone with obesity and body composition in African Americans. Clin Endocrinol (Oxf) 72:595–603CrossRef

38.

Costa AG, Bilezikian JP (2013) Bone turnover markers in primary hyperparathyroidism. J Clin Densitom 16:22–27CrossRefPubMedPubMedCentral

39.

Berger C, Almohareb O, Langsetmo L et al (2015) Characteristics of hyperparathyroid states in the Canadian Multicentre Osteoporosis Study (CaMos) and relationship to skeletal markers. Clin Endocrinol (Oxf) 82:359–368CrossRef

40.

Koumakis E, Souberbielle JC, Sarfati E, Meunier M, Maury E, Gallimard E, Borderie D, Kahan A, Cormier C (2013) Bone mineral density evolution after successful parathyroidectomy in patients with normocalcemic primary hyperparathyroidism. J Clin Endocrinol Metab 98:3213–3220CrossRefPubMed

41.

Lewiecki EM, Miller PD (2013) Skeletal effects of primary hyperparathyroidism: bone mineral density and fracture risk. J Clin Densitom 16:28–32CrossRefPubMed

Title: Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density
Authors: M. Li
F. Lv
Z. Zhang
W. Deng
Y. Li
Z. Deng
Y. Jiang
O. Wang
X. Xing
L. Xu
W. Xia
Publication date: 01-05-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 5/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3475-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2016

Bisphosphonates for prevention of osteopenia in kidney-transplant recipients: a systematic review of randomized controlled trials

A painful, never ending story: older women’s experiences of living with an osteoporotic vertebral compression fracture

Polymorphisms in Wnt signaling pathway genes are associated with peak bone mineral density, lean mass, and fat mass in Chinese male nuclear families

Swimming and bone: Is low bone mass due to hypogravity alone or does other physical activity influence it?

Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends

Associations between vitamin D metabolites, antiretroviral therapy and bone mineral density in people with HIV