Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, Japan.
J Bone Miner Metab. 2011 Jan;29(1):103-10. doi: 10.1007/s00774-010-0200-5. Epub 2010 Jun 22.
Vitamin D insufficiency is a risk for both skeletal and nonskeletal health. However, some ambiguity remains about threshold serum 25(OH)D for vitamin D insufficiency. To determine the threshold serum 25(OH)D to maintain normal calcium availability without elevation in serum parathyroid hormone (PTH) among Japanese subjects with various calcium intakes, we conducted a multicenter prospective open-labeled study. We recruited 107 ambulatory subjects without disorders affecting vitamin D metabolism to whom oral vitamin D₃ 800 IU/day for 4 weeks or 1,200 IU/day for 8 weeks was given. Serum 25(OH)D, PTH, calcium, phosphate, and magnesium were measured before and after vitamin D₃ supplementation. Calcium intake was assessed by questionnaires. When all the data were combined, serum 25(OH)D was negatively correlated with PTH. The cubic spline curve between serum 25(OH)D and PTH indicated PTH reached its plateau between 35 and 40 pg/ml at 25(OH)D between 25 and 30 ng/ml. Vitamin D₃ supplementation increased serum 25(OH)D and decreased PTH. Change in PTH correlated positively with baseline serum 25(OH)D. From the regression analyses, baseline serum 25(OH)D above 28 ng/ml corresponded to the threshold level without reduction in PTH after vitamin D₃ supplementation. In multivariate regression analyses, age but not calcium intake was a significant determinant of PTH. We concluded that a serum 25(OH)D level of 28 ng/ml was identified as a threshold for vitamin D insufficiency necessary to stabilize PTH to optimal levels.
维生素 D 不足与骨骼和非骨骼健康均相关。然而,血清 25(OH)D 诊断维生素 D 不足的阈值仍存在一些争议。为了确定日本人群在不同钙摄入量下,血清 25(OH)D 阈值以维持正常钙水平而不引起甲状旁腺激素(PTH)升高,我们进行了一项多中心前瞻性开放标签研究。我们招募了 107 例无影响维生素 D 代谢的疾病的门诊患者,这些患者在 4 周内每天口服维生素 D₃ 800IU 或 8 周内每天口服 1200IU。在补充维生素 D₃ 前后测量血清 25(OH)D、PTH、钙、磷和镁。通过问卷评估钙摄入量。当所有数据合并时,血清 25(OH)D 与 PTH 呈负相关。血清 25(OH)D 与 PTH 之间的三次样条曲线表明,在 25(OH)D 在 25-30ng/ml 之间时,PTH 在 35-40pg/ml 之间达到平台期。维生素 D₃ 补充增加了血清 25(OH)D 并降低了 PTH。PTH 的变化与基线血清 25(OH)D 呈正相关。从回归分析来看,基线血清 25(OH)D 高于 28ng/ml 对应于维生素 D₃ 补充后 PTH 无降低的阈值水平。在多变量回归分析中,年龄而不是钙摄入量是 PTH 的重要决定因素。我们得出结论,血清 25(OH)D 水平为 28ng/ml 被确定为维持 PTH 至最佳水平的维生素 D 不足的阈值。