The daily calcium profile in patients with chronic hypoparathyroidism depending on different 25(OH) vitamin D level

BACKGROUND: Chronic hypoparathyroidism is a relatively rare disease, which usually treated active forms of vitamin D and oral calcium supplements. Supplementation with native vitamin D can be useful both for achieving «non-skeletal» effects of vitamin D and for a more stable serum calcium profile.

AIM: The aim of this study was to estimate the daily serum calcium and 24-hour urine calcium levels depending on different 25(OH) vitamin D values in patients with chronic hypoparathyroidism on treatment of active forms of vitamin D and calcium supplements.

MATERIALS AND METHODS: Forty patients with chronic hypoparathyroidism were involved in the study. All patients were divided in two groups, matched on sex and age, according to the median level of 25(OH) vitamin D in the total group.

RESULTS: There were no significant differences between groups by total, albumin-adjusted serum calcium levels and urine calcium excretion. Patients with serum 25(ОН) vitamin D level ≥ 35 ng/ml had significant tendency to achieve more often the target levels of total serum calcium during the day (128 vs. 149 measurements during the day, p=0.049, χ²). However, this tendency disappeared for albumin-adjusted serum calcium levels (p=0.517, χ²). There frequency of hypercalcemia by albumin-adjusted serum calcium in the group of patients with 25(ОН) vitamin D ≥ 35 ng/ml (p=0.006, χ²) was significantly lower, but not for total serum calcium (a trend, p=0.042, χ²). As regards hypocalcemia, there were no significant differences by albumin-adjusted serum calcium (p=0.581, χ²) and it tends to lower frequency by total serum calcium (p=0.023, χ²).

CONCLUSION: The additional administration of native vitamin D in patients with chronic hypoparathyroidism may have some advantages, related to the general concept of worldwide vitamin D deficiency and better disease control.

1. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab. 2020;105(6):1722-1736. doi: https://doi.org/10.1210/clinem/dgaa113

2. Rossiiskaia assotsiatsiia endokrinologov. Klinicheskie rekomendatsii. Gipoparatireoz u vzroslykh. Moscow: 2021. (In Russ.). Доступно по: https://cr.minzdrav.gov.ru/recomend/627_2.

3. Kovaleva EV, Eremkina AK, Krupinova JA, et al. Review of clinical practice guidelines for hypoparathyroidism. Problems of Endocrinology. 2021;67(4):68-83. (In Russ.)]. doi: https://doi.org/10.14341/probl12800

4. Bandeira LC, Rubin MR, Cusano NE, Bilezikian JP. Vitamin D and hypoparathyroidism. Frontiers of Hormone Research. 2018;(50):114-124. doi: https://doi.org/10.1159/000486075

5. Babey M, Brandi M-L, Shoback D. Conventional treatment of hypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47(4):889-900. doi: https://doi.org/10.1016/j.ecl.2018.07.012

6. Lund B, Sorensen OH, Bishop JE, et al. Vitamin D metabolism in hypoparathyroidism. J Clin Endocrinol Metab. 1980;51(3):606-610. doi: https://doi.org/10.1210/jcem-51-3-606

7. Streeten EA, Mohtasebi Y, Konig M, et al. Hypoparathyroidism: Less Severe Hypocalcemia With Treatment With Vitamin D2 Compared With Calcitriol. J Clin Endocrinol Metab. 2017;102(5):1505-1510. doi: https://doi.org/10.1210/jc.2016-3712

8. Kovaleva EV, Ajnetdinova AR, Eremkina AK, Mokrysheva NG. Influence of deficiency or insufficiency of vitamin D on the circadian rhythm of serum calcium level. Obesity and metabolism. 2020;17(3):283-291. (In Russ.)] doi: https://doi.org/10.14341/omet12607

9. Hu H, Zhang J, Lu Y, et al. Association between circulating vitamin D level and urolithiasis: A systematic review and meta-analysis. Nutrients. 2017;9(3):301. doi: https://doi.org/10.3390/nu9030301

10. Malihi Z, Wu Z, Stewart AW, et al. Hypercalcemia, hypercalciuria, and kidney stones in long-term studies of vitamin D supplementation: a systematic review and meta-analysis. Am J Clin Nutr. 2016;104(4):1039-1051. doi: https://doi.org/10.3945/ajcn.116.134981

11. Johri N, Jaeger P, Ferraro PM, et al. Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk? Urolithiasis. 2017;45(6):535-543. doi: https://doi.org/10.1007/s00240-016-0954-x

12. Malihi Z, Lawes CMM, Wu Z, et al. Monthly high-dose vitamin D supplementation does not increase kidney stone risk or serum calcium: results from a randomized controlled trial. Am J Clin Nutr. 2019;109(6):1578-1587. doi: https://doi.org/10.1093/ajcn/nqy378

13. Kovaleva EV, Eremkina AK, Mokrysheva NG. Daily calcium profile in diagnosis of hypo- and hypercalcemia in patients with chronic hypoparathyroidism. clinical case series. Obesity and metabolism. 2021;18(2):175-179. (In Russ.)]. doi: https://doi.org/10.14341/omet12729

14. iner KK, Yanovski JA, Sarani B, Cutler Jr. GB. A randomized, cross-over trial of once-daily versus twice-daily parathyroid hormone 1–34 in treatment of hypoparathyroidism. J Clin Endocrinol Metab. 1998;83(10):3480-3486. doi: https://doi.org/10.1210/jcem.83.10.5185