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Risk factors for secondary hyperparathyroidism in a nursing home population.
- Source :
-
Clinical endocrinology [Clin Endocrinol (Oxf)] 1996 Apr; Vol. 44 (4), pp. 375-83. - Publication Year :
- 1996
-
Abstract
- Objective: Secondary hyperparathyroidism may cause bone loss and structural deterioration of bone and may thus be a cause of fracture in the elderly. Vitamin D deficiency, renal impairment and medications are potential causes of hyperparathyroidism and may also directly predispose to fracture. We present the first findings of an ongoing study of hip fracture, vitamin D deficiency and hyperparathyroidism in a large Australian nursing home.<br />Design: Descriptive prevalence study.<br />Patients: Two hundred and fifty-one nursing home residents were eligible for inclusion. Informed consent and successful venepuncture were obtained for 99. Residents were of median age 83 years with interquartile range (IR) 77-89 years.<br />Measurements: 25-Hydroxyvitamin D (25OHD), intact parathyroid hormone (PTH), creatinine and biochemistry, demographic data and current medications.<br />Results: Fifty-two per cent of 99 subjects had 25OHD below the reference range of 28-165 nmol/l and 96.5% were below the reference range mean. Those with low 25OHD had lower plasma calcium corrected for albumin than those with normal 25OHD (medians 2.34 vs 2.41 mmol/l, 95% confidence interval for the difference between medians (CI) -0.10 to -0.04 mmol/l, P = 0.0001) and higher PTH (medians 5.8 vs 3.9 pmol/l, CI 0.10-2.6 pmol/l, P = 0.0360). Twenty-eight per cent of 97 residents had PTH above the upper reference range limit of 6.5 pmol/l. Residents receiving frusemide had higher PTH than other residents (medians 6.95 vs 3.45 pmol/l, CI 1.9-4.2 pmol/l, P < 0.0001). In linear modelling, the most important predictor of the natural logarithm of PTH was daily frusemide dose, adjusted R2 (Ra2) = 31.8%, F = 39.3, P < 0.001. Creatinine and the reciprocal of 25OHD were other significant predictors with the final Ra2 = 39.4%, F = 17.7, P < 0.001.<br />Conclusions: Vitamin D deficiency is a common risk factor for secondary hyperparathyroidism in nursing home residents despite a climate in which vitamin D nutrition is thought to be ample. However, the daily frusemide dose is a more important predictor of PTH in this population.
- Subjects :
- Aged
Aged, 80 and over
Australia
Calcium blood
Female
Furosemide adverse effects
Hip Fractures etiology
Humans
Hyperparathyroidism, Secondary blood
Male
Middle Aged
Parathyroid Hormone blood
Risk Factors
Serum Albumin metabolism
Vitamin D Deficiency blood
25-Hydroxyvitamin D 2 deficiency
Homes for the Aged
Hyperparathyroidism, Secondary etiology
Nursing Homes
Vitamin D Deficiency complications
Subjects
Details
- Language :
- English
- ISSN :
- 0300-0664
- Volume :
- 44
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical endocrinology
- Publication Type :
- Academic Journal
- Accession number :
- 8706303
- Full Text :
- https://doi.org/10.1046/j.1365-2265.1996.701521.x