Normal parathyroid function with decreased bone mineral density: DISCUSSION Part 2

DISCUSSIONAn analysis of parathyroid function disclosed similar functioning in patients and controls, with all four measured parameters (maximal secretory capacity, suppressible fraction of I-PTH secretion, sensitivity of PTH secretion to ionized calcium changes or slope, and the set point of I-PTH stimulation by ionized calcium) being alike in both groups. There was a nonsignificant difference of +0.02 mmol/L ionized calcium in the set point between patients and normal control subjects. Such a difference could be sufficient, on theoretical grounds, to explain the difference in basal I-PTH concentrations between the two groups but would require much larger groups to be demonstrated experimentally. Overall, these results are reassuring because they do not disclose a residual increase in parathyroid function once the disease is treated and/or reflect a complete correction of possibly pre-existing minimal secondary hyperparathyroidism. All of the patients in the present study had basal I-PTH within the normal range, and it is possible that those with slightly elevated values, as described in other studies, could have disclosed slightly increased parathyroid function. However, even these cases are far from the severe secondary hyperparathyroidism seen in experimental models of calcium and vitamin D deficiency in dogs, suggesting that celiac disease is rarely associated with severe secondary hyperparathyroidism.

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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.

Normal parathyroid function with decreased bone mineral density: RESULTS Part 3

vitamin DBMD: Table 3 presents the results of lumbar and femoral BMD in the 17 patients. Compared with normal individuals of the same age (Z score), they had significantly lower lumbar BMD (-0.076±1.15 SDs, P<0.05) and femoral BMD (-0.60±0.96 SDs, P<0.05). Furthermore, six individuals had values less than -1 SDs at each site. Compared with young normal control subjects (T score), mean lumbar BMD (-1.4± 1.3 SDs, P<0.001) and femoral BMD (-1.3±0.9 SDs, P<0.001) were decreased by more than 1 SD in the 17 patients. Three patients were osteoporotic (less than -2.5 SDs) at the lumbar site, and two at the femoral site, while seven were osteopenic (less than -1 SDs and greater than -2.5 SDs) at the lumbar site, and eight at the femoral site. Fifty-nine per cent of the patients were either osteopenic or osteoporotic. Lumbar BMD (Table 4) was correlated with femoral BMD (R=0.641, P<0.01), age (R=-0.538, P<0.05), weight (R=0.664, P<0.005), height (R=0.706, P<0.005) and I-PTH (R=0.550, P<0.05) by regression analysis. In the latter case (I-PTH), the relationship was entirely explained by three patients – two with the lowest BMD and PTH values, and one with the highest BMD and PTH values. Only height remained significant by multivariate regression analysis (F=11.4, P<0.005). This was also true with logistical regression using lumbar T score less than -1 SDs as the threshold because height was identified as the only important covariate (X2=6.9, P<0.01). Femoral BMD (Table 4) was correlated with lumbar BMD (R=0.641, P<0.01), weight (R=0.879, P<0.0001), height (R=0.714, P<0.001) and creatinine (R=0.552, P<0.05) by regression analysis. Only weight remained significant by multivariate regression analysis (F=45.9, P<0.0001). With logistical regression analysis using the criteria previously identified, only weight remained significant (X2=8.56, P<0.005). You will be glad to come across costing you very little money.

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Normal parathyroid function with decreased bone mineral density: RESULTS Part 2

vitamin DBiochemical parameters and parathyroid function: The main characteristics of all normal control subjects and patients and of those who participated in the parathyroid function study are enumerated in Table 1. The biochemical parameters were similar in the two groups except for I-PTH values, which were higher in patients but still within the normal range (Figure 1). Mean 25-hydroxy vitamin D and 1,25-dihydroxy vitamin D values were also normal in patients, but three of them had 25-hydroxy vitamin D values below 35 nmol/L, the lower limit of the normal range. Findings in the two subgroups studied for parathyroid function were similar, illustrating that the higher I-PTH levels in patients were independent of age and sex. The results of parathyroid function are presented in Table 2 and illustrated in Figure 2 as means for each group. Stimulated I-PTH (maximum), nonsuppressible I-PTH (minimum), sensitivity to calcium changes (slope) and set point (ionized calcium values corresponding to half-stimulation) were similar in both groups.
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Normal parathyroid function with decreased bone mineral density: RESULTS Part 1

vitamin DClinical state: Mean patient age was 50.6±13.4 years. The four men (40±2 years) were younger than the women (54±12 years). The mean duration of celiac disease since diagnosis was 5.7±3.7 years and was similar in men (mean 4.8±2.2 years; range 1.1 to 8.1 years) and women (mean 5.8±3.9 years; range 1.1 to 15.9 years). All patients stated that they were compliant with their gluten-free diet. Their dietary response was assessed over time by repeat biopsy in the four men and eight of the women, with all of them, except one woman, having a normal or greatly improved histological picture. All 17 patients said they were clinically improved because of their diet, although reduced bowel movements, decreased abdominal cramps and weight gain were seen, usually only in the most severe cases. The direct role of gluten-free diet on specific biochemical defects was more difficult to appreciate because of simultaneous treatments with iron, folate, vitamin D and calcium. Nine women were postmenopausal, five were on hormone replacement therapy, and all were consuming calcium and vitamin D supplements. Two had been taking steroids intermittently, either orally or topically, for associated vasculitis and psoriasis. As a group, the patients were older than the controls and were mostly females, but the normal control subjects, who were chosen for parathyroid function, were perfectly matched to the patients for age and sex. There is a wonderful pharmacy offering , and you can shop with it.

Normal parathyroid function with decreased bone mineral density: SUBJECTS AND METHODS Part 3

vitamin DBMD: BMD of the lumbar spine (L2 to L4) and right femoral neck was measured by dual-energy x-ray absorptiometry (DXA), using a lunar DPX-IQ scanner (Lunar Corporation, USA). Measurement precision was better than 1.5% for the spine and 2.5% for the femoral neck. The results are expressed in g/cm . You can be sure your pharmacy offers delivering fast internationally.

Mathematical and statistical analyses: The data are presented as mean ± SD. Biochemical comparisons between normal control subjects and patients were performed by non-paired Student’s t test. Standard methods were used for unvariate and multivariate or logistical regression analysis. The parathyroid function of each individual was analyzed with a mathematical model fitting the sigmoidal relationship between I-PTH and ionized calcium concentrations, as described previously. A minimum of 15 points, derived from hypocalcemic and hypercalcemic infusions, was used for each analysis. Raw data were analyzed with the Origin nonlinear sigmoid curve fit module (Microcal Software Inc, USA). Fitting of the calculated curve to the experimental points was evaluated by the square of the correlation coefficient (R ). BMD is reported as absolute values (g/cm ), Z scores and T scores. The Z score represents the number of SDs that an individual value differs from the corresponding mean normal value for sex and age, while the T score represents the number of SDs that an individual value differs from the peak BMD (BMD at age 20 to 40 years) of a sex-matched, normal population. World Health Organization criteria were used to define osteopenia (T score less than -1 but greater than -2.5 SDs) and osteoporosis (T score less than -2.5 SDs). The Z and T scores of patients were compared with the respective reference populations of the DXA manufacturer, using the one-sample t test.

Normal parathyroid function with decreased bone mineral density: SUBJECTS AND METHODS Part 2

Vitamin DBiochemical measurements: Ionized calcium was measured immediately after blood collection with an ICA2 analyzer (Radiometer, Denmark); the interassay coefficients of variance were 3.3% and 2.7%, respectively, at concentrations of 0.77 mmol/L and 1.75 mmol/L. Serum phosphate, creatinine and alkaline phosphatase were quantified by automated colorimetry. Serum 25-hydroxy vitamin D and 1,25-dihydroxy vitamin D were measured after extraction with acetonitrile. 1,25-dihydroxy vitamin D was chromatographed on C-18 and silica cartridges before quantification 1,25-dihydroxy vitamin D assay. Serum PTH was measured by commercial radioimmunometric assay for intact human PTH (hPTH)- (Allegro Intact PTH, Nichols Institute Diagnostics, USA). This assay was initially reported to react only with hPTH- because available synthetic amino and carboxylterminal fragments did not react in the assay. Nonetheless, this and other commercial I-PTH assays have been demonstrated to react with a molecular form of PTH other than hPTH-in humans when sera obtained under various calcemic conditions were fractionated by high performance liquid chromatography. The non-PTH- molecular form represents approximately 20% of I-PTH in normal individuals. The reported detection limit of the assay is 0.1 pmol/L in the Nichol’s Institute brochure. The intra-assay coefficient of variance for duplicates is 3.1%. Best quality drugs are waiting – buy yasmin birth control to spend less time and money.


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