Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway.
Obes Surg. 2020 Sep;30(9):3426-3434. doi: 10.1007/s11695-020-04582-5.
Secondary hyperparathyroidism (SHPT) after obesity surgery may affect bone health. Optimal vitamin D levels have not been established to prevent SHPT postoperatively. We investigated whether SHPT differed across threshold levels of serum 25-hydroxyvitamin D (S-25(OH)D) from 6 months up to 5 years after Roux-en-Y gastric bypass (RYGB).
We included 554 patients at follow-up 5 years postoperatively. Blood samples were analysed for S-25(OH)D, ionized calcium (iCa) and parathyroid hormone (PTH) during follow-up.
PTH and prevalence of SHPT increased from 6 months to 5 years postoperatively, while S-25(OH)D and iCa decreased (all P < 0.001). PTH and SHPT development are related with S-25(OH)D, and PTH differed between all subgroups of S-25(OH)D. SHPT occurred less frequently across all subgroups of S-25(OH)D ≥ 50 nmol/l during follow-up: odds ratio (OR) 0.44 (95% CI 0.36-0.54) in patients with S-25(OH)D ≥ 50 nmol/l, OR 0.38 (0.30-0.49) with S-25(OH)D ≥ 75 nmol/l and OR 0.19 (0.12-0.31) with S-25(OH) D ≥ 100 nmol/l, all compared with S-25(OH)D < 50 nmol/l. At 5 years, 208/554 patients (38%) had SHPT; SHPT was found in 94/188 patients (50%) with S-25(OH)D < 50 nmol/l, in 69/222 (31%) with S-25(OH)D 50-74 nmol/l, in 40/117 (34%) with S-25(OH)D 75-99 nmol/l and in 5/27 (19%) with S-25(OH)D ≥ 100 nmol/l. An interaction existed between S-25(OH)D and iCa. Bone alkaline phosphatase remained increased with SHPT.
A significant relationship existed between S-25(OH)D and development of PTH and SHPT. The prevalence of SHPT was lower with threshold levels 25(OH)D ≥ 50 nmol/l and ≥ 75 nmol/l over the 5 years, and lowest with S-25(OH)D ≥ 100 nmol/l.
肥胖手术后的继发性甲状旁腺功能亢进症（SHPT）可能会影响骨骼健康。尚未确定最佳的维生素 D 水平以预防术后 SHPT。我们研究了在 Roux-en-Y 胃旁路术（RYGB）后 6 个月至 5 年内，血清 25-羟维生素 D（S-25（OH）D）水平不同阈值对 SHPT 的影响。
我们纳入了 554 名术后 5 年随访的患者。在随访期间，分析了 S-25（OH）D、离子钙（iCa）和甲状旁腺激素（PTH）的血液样本。
PTH 和 SHPT 的患病率从术后 6 个月到 5 年逐渐升高，而 S-25（OH）D 和 iCa 则降低（均 P<0.001）。PTH 和 SHPT 的发展与 S-25（OH）D 相关，且 PTH 在 S-25（OH）D 的所有亚组中存在差异。在整个 S-25（OH）D 亚组中，SHPT 的发生频率随 S-25（OH）D 水平的升高而降低：S-25（OH）D≥50nmol/l 患者的比值比（OR）为 0.44（95%CI 0.36-0.54），S-25（OH）D≥75nmol/l 患者的 OR 为 0.38（0.30-0.49），S-25（OH）D≥100nmol/l 患者的 OR 为 0.19（0.12-0.31），均与 S-25（OH）D<50nmol/l 患者相比。5 年后，554 名患者中有 208 名（38%）患有 SHPT；在 S-25（OH）D<50nmol/l 的 188 名患者中有 94 名（50%）、S-25（OH）D 为 50-74nmol/l 的 222 名患者中有 69 名（31%）、S-25（OH）D 为 75-99nmol/l 的 117 名患者中有 40 名（34%）和 S-25（OH）D≥100nmol/l 的 27 名患者中有 5 名（19%）发现 SHPT。S-25（OH）D 和 iCa 之间存在交互作用。骨碱性磷酸酶的活性仍随着 SHPT 而升高。
S-25（OH）D 与 PTH 和 SHPT 的发展之间存在显著关系。在 5 年内，SHPT 的患病率在 S-25（OH）D 阈值为≥50nmol/l 和≥75nmol/l 时较低，在 S-25（OH）D≥100nmol/l 时最低。
