Document Detail

Failure to normalize parathyroid hormone during treatment of vitamin D deficiency in Asian patients.
MedLine Citation:
PMID:  15521963     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Vitamin D deficiency and osteomalacia remain commonplace within the Asian community in Bradford. The treatment of vitamin D deficiency and osteomalacia is cheap and effective, but there are few data on long-term outcomes. Studies have suggested that a minority of patients fail to normalize parathyroid hormone (PTH) levels during therapy with vitamin D. This study aimed to determine what proportion of Asian patients with vitamin D deficiency and secondary hyperparathyroidism normalize PTH levels following therapy with oral vitamin D and to examine reasons for failure to normalize PTH. DESIGN: This study examined the impact of an oral regimen of vitamin D 800 i.u. (20 micrograms) and calcium 1000 mg daily, on PTH levels within an endocrinology outpatient clinic. patients 51 (4M:47F) Asian patients, median age 39 years (range 16-77 years) with vitamin D deficiency (25-hydroxyvitamin D < 25 nmol/l) and secondary hyperparathyroidism (PTH > 5.7 pmol/l). MEASUREMENTS: All patients had at least one follow-up measurement of PTH and calcium during treatment. A subgroup of patients gave consent for examination of GP-prescribing records to indirectly asses adherence to therapy. RESULTS: PTH normalized in only 28/51 (55%) patients (group N) and failed to normalize in 23/51 (45%) patients (group F). Baseline patient characteristics including: age, basal serum 25-hydroxyvitamin D (25OHD), basal serum PTH, basal serum calcium and post treatment serum calcium, were similar in groups N and F. Mild hypercalcaemia occurred in only two (3.9%) patients. The proportion of prescriptions collected by patients in group N was 75 (17-100)% and in group F was 17 (0-100)%, P < 0.0001. CONCLUSIONS: This study has demonstrated that long-term oral treatment with vitamin D and calcium, fails to normalize PTH in a significant proportion of patients with vitamin D deficiency and osteomalacia. This is most likely related to lack of adherence to long-term treatment. Improved ways of treating this condition need to be explored.
Steven R Peacey; Dianne Wright; Matthew J Harries
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  61     ISSN:  0300-0664     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-03     Completed Date:  2005-03-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  603-6     Citation Subset:  IM    
Department of Diabetes and Endocrinology, Bradford Teaching Hospitals NHS Trust, Bradford, UK.
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MeSH Terms
Administration, Oral
Asia / ethnology
Calcium / administration & dosage,  blood
Hyperparathyroidism, Secondary / blood,  drug therapy
Middle Aged
Parathyroid Hormone / blood*
Patient Compliance
Statistics, Nonparametric
Time Factors
Treatment Failure
Vitamin D / analogs & derivatives*,  blood,  therapeutic use*
Vitamin D Deficiency / blood,  drug therapy*
Reg. No./Substance:
0/Parathyroid Hormone; 1406-16-2/Vitamin D; 64719-49-9/25-hydroxyvitamin D; 7440-70-2/Calcium

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