Haden S T, Fuleihan G E, Angell J E, Cotran N M, LeBoff M S
Endocrine-Hypertension Division, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Harvard Medical School, Boston Massachusetts 02115, USA.
Calcif Tissue Int. 1999 Apr;64(4):275-9. doi: 10.1007/s002239900618.
We performed a retrospective study of 237 patients attending a specialty osteoporosis practice. Secondary causes for reduced bone mineral density (BMD) were evaluated in 196 postmenopausal women and 41 premenopausal women; mean age was 56 +/- 13.8 years (mean +/- SD). BMD was measured by dual-energy X-ray absorptiometry (DXA) (QDR 1000W/2000 Hologic). Levels of intact parathyroid hormone (iPTH), calcidiol [25(OH)D], thyroid-stimulating hormone, and 24-hour urinary calcium were measured, and serum and urine protein (SPEP and UPEP) electrophoresis were performed. Overall, 16% of our patients had 25(OH)D levels <15 ng/ml, the lowest acceptable vitamin D level without a concomitant rise in iPTH levels. Among the osteoporotic patients (T score <-2.5 SD), 17% had 25(OH)D levels <15 ng/ml and 7% <10 ng/ml. Among the osteopenic patients (-2.5 < T < -1.0 SD), 11% had 25(OH)D levels <15 ng/ml. Seventeen percent of patients with Z score </=-1.0 SD (low range normal value) had 25(OH)D levels <15 ng/ml. Low 25(OH)D levels were inversely related to high iPTH values (r = 0.30, P < 0.0001). Hypercalciuria was present in 15% of our patients, elevations of PTH levels (>65 pg/ml, upper normal limit of assay) were present in 11.5%, and hyperthyroidism in 4%. A 25(OH)D level of <25 ng/ml in women (n = 86) with no known secondary causes of low BMD was associated with an iPTH level above 49 pg/ml. The measurement of 25(OH)D levels is recommended in the evaluation of secondary causes for reduced BMD. Supplementation with vitamin D appears needed to keep 25(OH)D above 25 ng/ml, the level required to prevent increments in iPTH levels.
我们对237名在专业骨质疏松门诊就诊的患者进行了一项回顾性研究。对196名绝经后女性和41名绝经前女性评估了骨密度（BMD）降低的继发原因；平均年龄为56±13.8岁（均值±标准差）。采用双能X线吸收法（DXA）（QDR 1000W/2000 Hologic）测量BMD。检测了完整甲状旁腺激素（iPTH）、骨化二醇[25(OH)D]、促甲状腺激素水平以及24小时尿钙，并进行了血清和尿蛋白（SPEP和UPEP）电泳。总体而言，16%的患者25(OH)D水平<15 ng/ml，这是维生素D的最低可接受水平且iPTH水平无相应升高。在骨质疏松患者（T值<-2.5标准差）中，17%的患者25(OH)D水平<15 ng/ml，7%<10 ng/ml。在骨量减少患者（-2.5<T<-1.0标准差）中，11%的患者25(OH)D水平<15 ng/ml。Z值≤-1.0标准差（低范围正常值）的患者中，17%的患者25(OH)D水平<15 ng/ml。低25(OH)D水平与高iPTH值呈负相关（r = 0.30，P<0.0001）。15%的患者存在高钙尿症，11.5%的患者PTH水平升高（>65 pg/ml，检测的正常上限），4%的患者患有甲状腺功能亢进。在无已知低BMD继发原因的女性（n = 86）中，25(OH)D水平<25 ng/ml与iPTH水平高于49 pg/ml相关。建议在评估BMD降低的继发原因时检测25(OH)D水平。似乎需要补充维生素D以使25(OH)D保持在25 ng/ml以上，这是预防iPTH水平升高所需的水平。
