Normal parathyroid function with decreased bone mineral density: DISCUSSION Part 1

DISCUSSIONThis study was performed to ascertain whether basal I-PTH is still elevated and parathyroid function abnormalities are still present in treated patients with celiac disease. We were interested to see whether these were important determinants of actual BMD at the hip and lumbar spine. Your most trusted pharmacy offering cialis 200mg and giving you very fast shipping.

Basal measurements obtained in 26 normal control subjects who had participated, over the years, in parathyroid function studies were compared with those in 17 patients with biopsy-proven celiac disease treated with a gluten-free diet for a mean period of 5.7 years. Seven of these patients who underwent a parathyroid function test were also compared with seven sex- and age-matched controls subjected to similar testing. All biochemical parameters were similar in normal individuals and patients, except for the mean I-PTH level, which was significantly higher in patients; however, individual values were still in the normal range. The normal control subjects were younger than the patients, and most of the patients were females. These differences were abolished in the seven patients and seven matched controls who had parathyroid function tests, yet mean basal I-PTH was still significantly elevated in the patients, indicating that the I-PTH results were independent of age and sex. The mean I-PTH value obtained here is very similar to the mean values of treated patients reported by several groups using the same I-PTH assay. Most values obtained by others were also in the normal range, except in two recent studies, in which up to one-third of treated patients had values slightly above the normal range. The exact reason for this is unclear, higher values being generally seen in a small proportion of untreated patients or in those refractory to treatment. Eleven of the 12 patients who had a second biopsy while on treatment presented a corrected or improved histological picture and had PTH values in the normal range, while patients with elevated PTH values while on treatment demonstrated little improvement of their histological picture. This factor was not always considered in prior publications. Low 25-hydroxy vitamin D and 1,25-dihydroxy vitamin D levels have been implicated in increased mean I-PTH values, but these factors were unrelated to I-PTH levels in our study. In another investigation, the proportion of low 25-hydroxy vitamin D values decreased from 67.8% to 7.7% over five years of dietary treatment, while high I-PTH values fell from 21.4% to 15%. The proportion of low 25-hydroxy vitamin D values in the present study was 17.6% at the end of winter, but all I-PTH values were in the normal range. The small proportion of low 25-hydroxy vitamin D values in the present study may be related to eight menopausal women who were taking calcium and vitamin D supplements. This may also have contributed to the normal I-PTH values observed here.


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