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Laura P B Elbers Department of Internal Medicine, Medical Center Slotervaart, Amsterdam, the Netherlands
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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Marije Wijnberge Department of Internal Medicine, Medical Center Slotervaart, Amsterdam, the Netherlands
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, the Netherlands

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Joost C M Meijers Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands

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Dennis C W Poland Clinical Chemistry Laboratory, Medical Center Slotervaart, Amsterdam, the Netherlands

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Dees P M Brandjes Department of Internal Medicine, Medical Center Slotervaart, Amsterdam, the Netherlands
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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Eric Fliers Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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Victor E A Gerdes Department of Internal Medicine, Medical Center Slotervaart, Amsterdam, the Netherlands
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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Introduction

Abnormal coagulation tests have been observed in patients with primary hyperparathyroidism (HPT) suggesting a prothrombotic effect of parathyroid hormone (PTH). Vitamin D deficiency (VIDD) is the most frequent cause of secondary HPT. Aim of our study was to investigate the influence of HPT secondary to moderate-to-severe VIDD and vitamin D replacement on the coagulation and fibrinolysis system.

Subjects and methods

Prospective cohort study of patients with vitamin D <25 nmol/L with and without HPT, and a control group of patients on vitamin D suppletion. At baseline and after 2 months of vitamin D suppletion (900,000 IU in 2 months), endocrine and coagulation markers were measured.

Results

59 patients with VIDD of which 34 had secondary HPT and 36 controls were included. After 2 months of suppletion, vitamin D increased by 399% (VIDD with HPT), 442% (all patients with VIDD) and 6% (controls). PTH decreased by 34% (VIDD with HPT, P < 0.01 for decrease), 32% (all VIDD, P < 0.01) and increased by 8% in the controls (P-values: <0.01 for relative changes between VIDD with HPT or all VIDD patients vs controls). Relative changes in PT, aPTT, fibrinogen, Von Willebrand factor, factors VII, VIII and X, thrombin generation, TAFI, clot-lysis time and d-dimer were not different between patients with VIDD with HPT or all VIDD vs controls.

Discussion

Secondary HPT due to VIDD does not have a prothrombotic effect. In contrast with previous reports, PTH does not seem to influence coagulation or fibrinolysis, which is relevant because of the high prevalence of VIDD.

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Rong Xu Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Difei Lian Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Yan Xie Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Lin Mu Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Yali Wu Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Zhilei Chen Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Baoyu Zhang Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
Beijing Key Laboratory of Diabetes Research and Care, Beijing, China

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Osteoporosis (OP) is a systemic bone disease in which bone density and quality decrease and bone fragility increases due to a variety of causes, making it prone to fractures. The development of OP is closely related to oxidative stress. Uric acid (UA) is the end product of purine metabolism in the human body. Extracellular UA has antioxidant properties and is thought to have a protective effect on bone metabolism. However, the process of UA degradation can lead to intracellular oxidative stress, which together with UA-induced inflammatory factors, leads to increased bone destruction. In addition, UA can inhibit vitamin D production, resulting in secondary hyperparathyroidism and further exacerbating UA-associated bone loss. This review summarizes the relationship between serum UA levels and bone mineral density, bone turnover markers, and so on, in the hope of providing new insights into the pathogenesis and treatment of OP.

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Karoline Winckler Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Lise Tarnow Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology
Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology
Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Louise Lundby-Christensen Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology
Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Thomas P Almdal Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology
Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Niels Wiinberg Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Pia Eiken Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology
Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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Trine W Boesgaard Department of Cardiology, Department of Research, Institute of Clinical Studies, Clinical Research Unit, Department of Paediatrics, Department of Medicine, Department of Physiology and Nuclear Medicine, Institute of Clinical Medicine, Nephrology and Endocrinology

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the CIMT trial group
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Despite aggressive treatment of cardiovascular disease (CVD) risk factors individuals with type 2 diabetes (T2D) still have increased risk of cardiovascular morbidity and mortality. The primary aim of this study was to examine the cross-sectional association between total (25-hydroxy vitamin D (25(OH)D)) and risk of CVD in patients with T2D. Secondary objective was to examine the association between 25(OH)D and bone health. A Danish cohort of patients with T2D participating in a randomised clinical trial were analysed. In total 415 patients (68% men, age 60±9 years (mean±s.d.), duration of diabetes 12±6 years), including 294 patients (71%) treated with insulin. Carotid intima–media thickness (IMT) and arterial stiffness (carotid artery distensibility coefficient (DC) and Young's elastic modulus (YEM)) were measured by ultrasound scan as indicators of CVD. Bone health was assessed by bone mineral density and trabecular bone score measured by dual energy X-ray absorptiometry. In this cohort, 214 patients (52%) were vitamin D deficient (25(OH)D <50 nmol/l). Carotid IMT was 0.793±0.137 mm, DC was 0.0030±0.001 mmHg, YEM was 2354±1038 mmHg and 13 (3%) of the patients were diagnosed with osteoporosis. A 25(OH)D level was not associated with carotid IMT or arterial stiffness (P>0.3) or bone health (P>0.6) after adjustment for CVD risk factors. In conclusion, 25(OH)D status was not associated with carotid IMT, arterial stiffness or bone health in this cohort of patients with T2D. To explore these associations and the association with other biomarkers further, multicentre studies with large numbers of patients are required.

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Malachi J McKenna Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

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Barbara F Murray Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

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Myra O'Keane Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

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Mark T Kilbane Metabolism Laboratory, Department of Endocrinology, School of Medicine and Medical Sciences, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

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Background

The Institute of Medicine 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D specified higher intakes for all age groups compared to the 1997 report, but also cautioned against spurious claims about an epidemic of vitamin D deficiency and against advocates of higher intake requirements. Over 40 years, we have noted marked improvement in vitamin D status but we are concerned about hypervitaminosis D.

Objective

We sought to evaluate the 25-hydroxyvitamin D (25OHD) trend over 20 years.

Design

We retrieved all results of serum 25OHD from 1993 to 2013 (n=69 012) that was trimmed to one sample per person (n=43 782). We conducted a time series analysis of the monthly averages for 25OHD using a simple sequence chart and a running median smoothing function. We modelled the data using univariate auto-regressive integrated moving average (ARIMA) and forecast 25OHD levels up to 2016.

Results

The time series sequence chart and smoother function demonstrated a steady upward trend with seasonality. The yearly average 25OHD increased from 36.1 nmol/l in 1993 to 57.3 nmol/l in 2013. The ARIMA model was a good fit for the 25OHD time series; it forecasted monthly average 25OHD up to the end of 2016 with a positive stationary R 2 of 0.377.

Conclusions

Vitamin D status improved over the past 40 years, but there remains a dual problem: there are groups at risk of vitamin D deficiency who need public health preventative measures; on the other hand, random members of the population are taking unnecessarily high vitamin D intakes for unsubstantiated claims.

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Nancy Martini Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM-UNLP-CICPBA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina

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Lucas Streckwall Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM-UNLP-CICPBA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina

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Antonio Desmond McCarthy Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM-UNLP-CICPBA), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina

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In post-menopausal women, aged individuals, and patients with diabetes mellitus or chronic renal disease, bone mineral density (BMD) decreases while the vasculature accumulates arterial calcifications (ACs). AC can be found in the tunica intima and/or in the tunica media. Prospective studies have shown that patients with initially low BMD and/or the presence of fragility fractures have at follow-up a significantly increased risk for coronary and cerebrovascular events and for overall cardiovascular mortality. Similarly, patients presenting with abdominal aorta calcifications (an easily quantifiable marker of vascular pathology) show a significant decrease in the BMD (and an increase in the fragility) of bones irrigated by branches of the abdominal aorta, such as the hip and lumbar spine. AC induction is an ectopic tissue biomineralization process promoted by osteogenic transdifferentiation of vascular smooth muscle cells as well as by local and systemic secreted factors. In many cases, the same regulatory molecules modulate bone metabolism but in reverse. Investigation of animal and in vitro models has identified several potential mechanisms for this reciprocal bone–vascular regulation, such as vitamin K and D sufficiency, advanced glycation end-products–RAGE interaction, osteoprotegerin/RANKL/RANK, Fetuin A, oestrogen deficiency and phytooestrogen supplementation, microbiota and its relation to diet, among others. Complete elucidation of these potential mechanisms, as well as their clinical validation via controlled studies, will provide a basis for pharmacological intervention that could simultaneously promote bone and vascular health.

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Raja Padidela Royal Manchester Children’s Hospital and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

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Moira S Cheung Evelina London Children’s Hospital, London, UK

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Vrinda Saraff Birmingham Women’s and Children’s Hospital, Birmingham, UK

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Poonam Dharmaraj Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

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X-linked hypophosphataemia (XLH) is caused by a pathogenic variant in the PHEX gene, which leads to elevated circulating FGF23. High FGF23 causes hypophosphataemia, reduced active vitamin D concentration and clinically manifests as rickets in children and osteomalacia in children and adults. Conventional therapy for XLH includes oral phosphate and active vitamin D analogues but does not specifically treat the underlying pathophysiology of elevated FGF23-induced hypophosphataemia. In addition, adherence to conventional therapy is limited by frequent daily dosing and side effects such as gastrointestinal symptoms, secondary hyperparathyroidism and nephrocalcinosis. Burosumab, a recombinant human IgG1 MAB that binds to and inhibits the activity of FGF23, is administered subcutaneously every 2 weeks. In clinical trials (phase 2 and 3) burosumab was shown to improve phosphate homeostasis that consequently resolves the skeletal/non-skeletal manifestations of XLH. Burosumab was licensed in Europe (February 2018) with the National Institute for Health and Care Excellence, UK approving use within its marketing authorisation in October 2018. In this publication, the British Paediatric and Adolescent Bone Group (BPABG) reviewed current evidence and provide expert recommendations for care pathway and management of XLH with burosumab.

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Tomás P Griffin Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland
Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland

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Caroline M Joyce Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland

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Sumaya Alkanderi Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

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Liam M Blake Department of Clinical Biochemistry, SUHCG, GUH, Galway, Ireland

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Derek T O’Keeffe Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland

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Delia Bogdanet Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland

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Md Nahidul Islam Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland
Department of Clinical Biochemistry, SUHCG, GUH, Galway, Ireland

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Michael C Dennedy Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland
Lambe Institute for Translational Research, School of Medicine, NUIG, Galway, Ireland

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John E Gillan Department of Histopathology, SUHCG, GUH, Galway, Ireland

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John J Morrison Department of Obstetrics and Gynaecology, SUHCG, GUH, Galway, Ireland

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Timothy O’Brien Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland
Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland

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John A Sayer Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK

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Marcia Bell Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group (SUHCG), Galway University Hospitals (GUH), Galway, Ireland

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Paula M O’Shea Department of Clinical Biochemistry, SUHCG, GUH, Galway, Ireland

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Introduction

Inactivating mutations in CYP24A1, encoding vitamin D-24-hydroxylase, can lead to an accumulation of active vitamin D metabolites and consequent hypercalcaemia. Patient (infantile and adult) presentation is varied and includes mild-severe hypercalcaemia, hypercalciuria, nephrocalcinosis and nephrolithiasis. This study aimed to characterize the clinical and biochemical phenotypes of a family with two CYP24A1 missense variants.

Methods

The proband and seven family members underwent detailed clinical and biochemical evaluation. Laboratory measurements included serum calcium, intact parathyroid hormone (iPTH), vitamin D metabolites and urine calcium and creatinine.

Results

The proband presented during the second trimester of a planned pregnancy with flu-like symptoms. Laboratory tests showed elevated adjusted calcium of 3.27 (upper reference limit (URL: 2.30) mmol/L), suppressed iPTH (<6 ng/L), elevated 25(OH)D (264 (URL: 55) nmol/L) and elevated 1,25(OH)D (293 (URL: <280) pmol/L). Ionized calcium was 1.55 (URL: 1.28) mmol/L. Sanger sequencing revealed two heterozygous missense variants in the CYP24A1: p.(Arg439Cys), R439C and p.(Trp275Arg), W275R. The proband’s brother and sister had the same genotype. The brother had intermittent hypercalcaemia and hypervitaminosis D. Only the sister had a history of nephrolithiasis. The proband’s daughter and two nephews were heterozygous for the R439C variant. The proband and her brother frequently had elevated 25(OH)D:24,25(OH)2D ratios (>50) during follow-up.

Conclusions

W275R is a new pathogenic CYP24A1 mutation in compound heterozygotic form with R439C in this family.

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Agnès Linglart Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Martin Biosse-Duplan Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Karine Briot Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Catherine Chaussain Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Laure Esterle Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Séverine Guillaume-Czitrom Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Peter Kamenicky Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Jerome Nevoux Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Dominique Prié Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Anya Rothenbuhler Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Philippe Wicart Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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Pol Harvengt Service d'Endocrinologie et Diabétologie de l'Enfant, Service de Pédiatrie générale – Consultation de rhumatologie, Service d'Endocrinologie et des Maladies de la Reproduction, Service d'ORL et chirurgie cervico-maxillo-faciale, Université Paris 11, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Service d'Odontologie-Maladies Rares Hôpital Bretonneau 2 rue Carpeaux, Université Paris Descartes 12 Rue de l'École de Médecine, Service Rhumatologie B Hôpital Cochin, Centre de Référence des Maladies Rares des Maladies Auto-Inflammatoires Rares de l'Enfant, Service d'explorations fonctionnelles rénales, Service de Chirurgie infantile orthopédique, Association de patients RVRH-XLH, Hôpital Bicêtre, APHP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

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In children, hypophosphatemic rickets (HR) is revealed by delayed walking, waddling gait, leg bowing, enlarged cartilages, bone pain, craniostenosis, spontaneous dental abscesses, and growth failure. If undiagnosed during childhood, patients with hypophosphatemia present with bone and/or joint pain, fractures, mineralization defects such as osteomalacia, entesopathy, severe dental anomalies, hearing loss, and fatigue. Healing rickets is the initial endpoint of treatment in children. Therapy aims at counteracting consequences of FGF23 excess, i.e. oral phosphorus supplementation with multiple daily intakes to compensate for renal phosphate wasting and active vitamin D analogs (alfacalcidol or calcitriol) to counter the 1,25-diOH-vitamin D deficiency. Corrective surgeries for residual leg bowing at the end of growth are occasionally performed. In absence of consensus regarding indications of the treatment in adults, it is generally accepted that medical treatment should be reinitiated (or maintained) in symptomatic patients to reduce pain, which may be due to bone microfractures and/or osteomalacia. In addition to the conventional treatment, optimal care of symptomatic patients requires pharmacological and non-pharmacological management of pain and joint stiffness, through appropriated rehabilitation. Much attention should be given to the dental and periodontal manifestations of HR. Besides vitamin D analogs and phosphate supplements that improve tooth mineralization, rigorous oral hygiene, active endodontic treatment of root abscesses and preventive protection of teeth surfaces are recommended. Current outcomes of this therapy are still not optimal, and therapies targeting the pathophysiology of the disease, i.e. FGF23 excess, are desirable. In this review, medical, dental, surgical, and contributions of various expertises to the treatment of HR are described, with an effort to highlight the importance of coordinated care.

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Christian Trummer Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

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Stefan Pilz Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

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Verena Schwetz Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

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Barbara Obermayer-Pietsch Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

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Elisabeth Lerchbaum Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

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Background

Accumulating evidence from animal and human studies suggests that vitamin D is involved in many functions of the reproductive system in both genders.

Aim

The aim of this review was to provide an overview on the effects of vitamin D on polycystic ovary syndrome (PCOS) in women and androgen metabolism in men.

Methods

We performed a systematic literature search in PubMed for relevant English language publications published from January 2012 until September 2017.

Results and discussion

The vitamin D receptor and vitamin D-metabolizing enzymes are found in reproductive tissues of women and men. In women, vitamin D status has been associated with several features of PCOS. In detail, cross-sectional data suggest a regulatory role of vitamin D in PCOS-related aspects such as ovulatory dysfunction, insulin resistance as well as hyperandrogenism. Moreover, results from randomized controlled trials (RCTs) suggest that vitamin D supplementation may be beneficial for metabolic, endocrine and fertility aspects in PCOS. In men, vitamin D status has been associated with androgen levels and hypogonadism. Further, there is some evidence for a favorable effect of vitamin D supplementation on testosterone concentrations, although others failed to show a significant effect on testosterone levels.

Conclusion

In summary, vitamin D deficiency is associated with adverse fertility outcomes including PCOS and hypogonadism, but the evidence is insufficient to establish causality. High-quality RCTs are needed to further evaluate the effects of vitamin D supplementation in PCOS women as well as on androgen levels in men.

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Adriana J van Ballegooijen Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Marjolein Visser Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Marieke B Snijder Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Jacqueline M Dekker Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Giel Nijpels Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Coen D A Stehouwer Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Michaela Diamant Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Ingeborg A Brouwer Department of Health Sciences, Department of Epidemiology and Biostatistics, Department of Public Health, Department of General Practice, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

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Objective

A disturbed vitamin D–parathyroid hormone (PTH)–calcium axis may play a role in the pathogenesis of heart failure. Therefore, we investigated whether lower 25-hydroxyvitamin D (25(OH)D) and higher PTH are cross sectionally and after 8 years of follow-up associated with higher B-type natriuretic peptide (BNP) levels in older men and women.

Design and methods

We measured baseline 25(OH)D, PTH, and BNP in 502 subjects in 2000–2001 in the Hoorn Study, a population-based cohort. Follow-up BNP was available in 2007–2009 in 278 subjects. Subjects were categorized according to season- and sex-specific quartiles of 25(OH)D and PTH at baseline. We studied the association of 25(OH)D and PTH quartiles with BNP using linear regression analyses adjusting for confounders. Analyses were stratified by kidney function estimated glomerular filtration rate (eGFR; ≤60 ml/min per 1.73 m2) because of significant interaction.

Results

At baseline, subjects had a mean age of 69.9±6.6 years, mean 25(OH)D level was 52.2±19.5 nmol/l and mean PTH 6.1±2.4 pmol/l. Cross sectionally, 25(OH)D was associated with BNP in subjects with impaired kidney function (eGFR ≤60 ml/min) only. The association attenuated after adjustment for PTH. PTH was cross sectionally associated with BNP, also in subjects with impaired kidney function only: regression coefficient of highest quartile 9.9 pmol/l (95% confidence interval 2.5, 17.4) with a significant trend across quartiles. Neither 25(OH)D nor PTH was associated with BNP in longitudinal analyses.

Conclusion

This study showed overall no strong association between 25(OH)D and BNP. However, PTH was associated with BNP in subjects with impaired kidney function and may point to a potential role in myocardial function.

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