Hypovitaminosis D and parathyroid hormone response in the elderly: effects on bone turnover and mortality

Clin Endocrinol (Oxf). 2008 Feb;68(2):290-8. doi: 10.1111/j.1365-2265.2007.03040.x. Epub 2007 Sep 14.


Objective: To investigate whether absence of secondary hyperparathyroidism in the presence of hypovitaminosis D has altered bone turnover, fracture risk and mortality.

Design: A prospective cohort study.

Patients: A total of 1280 older men and women living in residential care facilities.

Measurements: We measured baseline serum 25-hydroxyvitamin D (25OHD), serum intact PTH, serum amino-terminal propeptide of type I collagen (PINP) and serum carboxy-terminal telopeptide of type I collagen (CTX-I). Deaths and fractures were recorded prospectively.

Results: Hypovitaminosis D (25OHD < 39 nmol/l) and absence of secondary hyperparathyroidism (PTH > 7.0 pmol/l) in the presence of hypovitaminosis D were common in this sample with a prevalence of 77.5% and 53.3%, respectively. In the presence of hypovitaminosis D, residents showing a hyperparathyroid response (n = 406) had significantly higher serum bone turnover markers than individuals with serum PTH levels < or = 7.0 pmol/l (termed 'low vitamin D, normal PTH', n = 463). After adjusting for risk factors, mortality was significantly higher in the secondary hyperparathyroidism group than in the 'low vitamin D, normal PTH' group [hazard ratio (HR) = 1.35, 95% confidence interval (CI) 1.12-1.64; P = 0.002]. All residents with serum PTH levels < or = 7.0 pmol/l (n = 603) were similar with regard to both bone turnover and mortality, independent of their actual vitamin D status.

Conclusion: Absence of secondary hyperparathyroidism in the presence of hypovitaminosis D appears to be common in the frail elderly and is associated with longer survival, similar to that observed in vitamin D-replete elderly subjects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone and Bones / metabolism
  • Bone and Bones / pathology
  • Female
  • Fractures, Bone / blood
  • Fractures, Bone / metabolism
  • Humans
  • Hyperparathyroidism / complications
  • Hyperparathyroidism, Secondary / blood
  • Hyperparathyroidism, Secondary / metabolism
  • Hyperparathyroidism, Secondary / mortality*
  • Male
  • Parathyroid Hormone / blood
  • Prospective Studies
  • Risk Factors
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / metabolism*
  • Vitamin D Deficiency / mortality*


  • Parathyroid Hormone
  • Vitamin D
  • 25-hydroxyvitamin D