低维生素D对原发性甲状旁腺功能亢进症患者骨体积密度、骨微结构及骨硬度的影响
Effect of Low Vitamin D on Volumetric Bone Mineral Density, Bone Microarchitecture, and Stiffness in Primary Hyperparathyroidism.
作者信息
Walker Marcella D, Nishiyama Kyle K, Zhou Bin, Cong Elaine, Wang Ji, Lee James A, Kepley Anna, Zhang Chengchen, Guo X Edward, Silverberg Shonni J
机构信息
Department of Medicine (M.D.W., K.K.N., E.C., A.K., C.Z., S.J.S.), Columbia University, College of Physicians and Surgeons, New York, New York 10032; Bone Bioengineering Laboratory (B.Z., J.W., X.E.G.), Columbia University, New York, New York 10027; Department of Surgery (J.A.L.), Columbia University, College of Physicians and Surgeons, New York, New York 10032.
出版信息
J Clin Endocrinol Metab. 2016 Mar;101(3):905-13. doi: 10.1210/jc.2015-4218. Epub 2016 Jan 8.
CONTEXT
Patients with 25-hydroxyvitamin D deficiency (25OHD <20 ng/ml) and primary hyperparathyroidism (PHPT) have more severe disease reflected by higher serum PTH levels compared to those with vitamin D levels in the insufficient (20-29 ng/ml) or replete range (≥ 30 ng/ml).
OBJECTIVE
To study the effect of low vitamin D in PHPT on volumetric bone mineral density (vBMD), bone microarchitecture, and bone strength.
DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional analysis of 99 PHPT patients with and without 25OHD insufficiency and deficiency from a university hospital.
OUTCOME MEASURES
Bone microarchitecture and strength were assessed with high-resolution peripheral quantitative computed tomography (HRpQCT), microfinite element analysis, and individual trabecula segmentation.
RESULTS
In this cohort, 25OHD levels were deficient in 18.1%, insufficient in 35.4% and replete in 46.5%. Those with lower 25OHD levels had higher PTH (P < .0001), were younger (P = .001) and tended to weigh more (P = .053). There were no age-, weight- and sex-adjusted between-group differences (<20 vs 20-29 vs ≥ 30 ng/ml) in any HRpQCT, microfinite element analysis, or individual trabecula segmentation indices. Because few participants had 25OHD below 20 ng/ml, we also compared those with 25OHD below 30 vs at least 30 ng/ml and found only a trend toward lower adjusted cortical vBMD (3.1%, P = .08) and higher cortical porosity (least squares mean ± SEM 7.5 ± 0.3 vs 6.6 ± 0.3%, P = .07) at the tibia but not the radius. Stiffness did not differ at either site. In multiple regression analysis, 25OHD accounted for only three of the 49.2% known variance in cortical vBMD; 25OHD was not significant in the model for cortical porosity at the tibia.
CONCLUSION
Low 25OHD levels are associated with higher PTH levels in PHPT, but contrary to our hypothesis, these differences did not significantly affect vBMD or microarchitecture, nor did they result in lower stiffness. Low vitamin D in PHPT using current 25OHD thresholds for insufficiency and deficiency did not significantly affect skeletal integrity as assessed by HRpQCT.
背景
与维生素D水平处于不足（20 - 29 ng/ml）或充足范围（≥30 ng/ml）的患者相比，25 - 羟基维生素D缺乏（25OHD <20 ng/ml）且患有原发性甲状旁腺功能亢进症（PHPT）的患者疾病更为严重，表现为血清甲状旁腺激素（PTH）水平更高。
目的
研究PHPT患者中低维生素D水平对骨体积密度（vBMD）、骨微结构和骨强度的影响。
设计、地点和参与者：这是一项对某大学医院99例患有和未患有25OHD不足及缺乏的PHPT患者进行的横断面分析。
观察指标
采用高分辨率外周定量计算机断层扫描（HRpQCT）、微有限元分析和单个小梁分割来评估骨微结构和强度。
结果
在该队列中，25OHD水平缺乏的患者占18.1%，不足的占35.4%，充足的占46.5%。25OHD水平较低的患者PTH水平较高（P <.0001），年龄较小（P =.001），且体重有增加趋势（P =.053）。在任何HRpQCT、微有限元分析或单个小梁分割指标方面，按年龄、体重和性别调整后，组间差异（<20 vs 20 - 29 vs≥30 ng/ml）均不存在。由于仅有少数参与者的25OHD低于20 ng/ml，我们还比较了25OHD低于30 ng/ml与至少为30 ng/ml的参与者，发现仅在胫骨部位有调整后的皮质vBMD降低趋势（3.1%，P =.08）以及皮质孔隙率升高趋势（最小二乘均值±标准误 7.5±0.3 vs 6.6±0.3%，P =.07），而在桡骨部位未出现此情况。两个部位的刚度均无差异。在多元回归分析中，25OHD仅占皮质vBMD已知方差的49.2%中的3%；在胫骨皮质孔隙率模型中，25OHD不显著。
结论
PHPT患者中低25OHD水平与较高的PTH水平相关，但与我们的假设相反，这些差异并未显著影响vBMD或微结构，也未导致刚度降低。按照目前25OHD不足和缺乏的阈值，PHPT患者中低维生素D水平对通过HRpQCT评估的骨骼完整性没有显著影响。
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