Tibial tenderness identifies secondary hyperparathyroidism responding to high-dose vitamin D in Pakistani women

Endocr Pract. 2013 Jul-Aug;19(4):596-601. doi: 10.4158/EP11113.OR.


Objective: To assess the utility of anterior tibial tenderness (ATT) measured by visual analogue scoring (VAS) as a clinical diagnostic tool for vitamin D deficiency in a high-risk population of Pakistani women.

Methods: ATT was measured by VAS in 75 premenopausal women age 17 to 56 years (mean, 41.3 years) with generalized aches and pains and calcium <11 mg/dL (normal, 8 to 11 mg/dL) who were seen at a tertiary care center in Lahore, Pakistan. This was followed by administration of 1.8 million units of vitamin D3 in divided doses. ATT, vitamin D, and parathyroid hormone (PTH) levels were checked before and after the injections. Correlation between ATT, vitamin D, and PTH, as well as changes in ATT, vitamin D, and PTH following supplementation were determined.

Results: Pre-intervention average calcium and vitamin D were 9.3 mg/dL (range, 8 to 10.3 mg/dL) and 12.1 ng/mL (range, 1.5 to 32.6 ng/mL), respectively. Seventy-four percent of the participants (53/75) had vitamin D deficiency and elevated PTH (>60 pg/mL). Mean PTH was 81.6 pg/mL (range, 29.1 to 370 pg/mL). Changes in ATT correlated strongly (r = 0.422; P = .013) with changes in PTH. Following supplementation, there was significant improvement in ATT (P<.01) and vitamin D level (P<.01), with a decrease in PTH level (P<.01).

Conclusion: ATT is a valid clinical diagnostic measure of vitamin D deficiency in South Asian women.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / diagnosis*
  • Hyperparathyroidism, Secondary / drug therapy
  • Hyperparathyroidism, Secondary / physiopathology
  • Middle Aged
  • Pakistan
  • Tibia / physiopathology*
  • Vitamin D / administration & dosage
  • Vitamin D / therapeutic use*
  • Vitamin D Deficiency / diagnosis*
  • Vitamin D Deficiency / drug therapy
  • Vitamin D Deficiency / physiopathology
  • Young Adult


  • Vitamin D