This article is more than 5 years old. Information may no longer be current.
Vitamin D3 therapy may affect calcium/creatinine clearance ratio in primary hyperparathyroidism
Serum 1,25-dihydroxyvtamin D3 and osteocalcin are significantly correlated with the calcium/creatinine clearance ratio in adults with primary hyperparathyroidism revealing that the diagnostic value of calcium/creatinine clearance ratio may be affected with vitamin D3 replacement therapy, according to researchers in Switzerland.
Reto Martin Kaderli, MD, of the department of visceral surgery and medicine, Inselspital, Bern University Hospital, University of Bern in Switzerland, and colleagues evaluated 381 adults (median age, 59 years; 71.4% women) with primary parahyperthyroidism and preoperative workup 2 days before removal of a solitary parathyroid adenoma to determine the parameters affecting calcium/creatinine clearance ratio.
Ionized calcium and albumin-corrected calcium were strongly correlated with calcium, and osteocalcin was strongly associated with alkaline phosphatase, beta-crosslaps, procollagen type 1 n-terminal propeptide and bone-specific alkaline phosphatase. Calcium/creatinine clearance ratio and 24-hour urinary creatinine were not associated with bone mineral density at the lumbar spine, distal radius or femoral neck.
Serum 1,25-(OH)2 D3 had the highest impact on calcium/creatinine clearance ratio (P < .001). Calcium/creatinine clearance ratio was also significantly associated with calcium (P < .001), ionized calcium (P = .001), albumin-corrected calcium (P < .001), 25-(OH)D3 (P = .005), osteocalcin (P = .01) and beta-crosslaps (P < .001).
“In conclusion, 1,25-(OH)2 D3 and, to a much lesser extent, elevated osteocalcin were the only parameters related to higher [calcium/creatinine clearance ratio],” the researchers wrote. “This finding could have a clinical impact on vitamin D3 substitution in patients with [primary hyperparathyroidism]. Vitamin D3 replacement may impair the diagnostic value of [calcium/creatinine clearance ratio] and increase the importance of close urinary [calcium] excretion monitoring during treatment due to the side effects of increased urinary [calcium] with urinary stone disease and nephrocalcinosis. None of the other preoperative parameters were related to higher [calcium/creatinine clearance ratio] and these do not, therefore, have to be taken into account in the diagnostic value of [calcium/creatinine clearance ratio] for the distinction of [familial hypocalciuric hypercalcemia] from [primary hyperparathyroidism].” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.