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. 2017 Apr 19;1(6):615-624.
doi: 10.1210/js.2017-00104. eCollection 2017 Jun 1.

Longitudinal Assessment of PTH in Community-Dwelling Older Women-Elevations Are Not Associated With Mortality

David Buchebner  1   2 , Linnea Malmgren  1 , Anders Christensson  3 , Fiona McGuigan  1 , Paul Gerdhem  4 , Martin Ridderstråle  5 , Kristina Åkesson  1
Affiliations

Longitudinal Assessment of PTH in Community-Dwelling Older Women-Elevations Are Not Associated With Mortality

David Buchebner et al. J Endocr Soc. .

Abstract

Context: In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear.

Objective: To describe normal PTH profiles over time and the association with mortality.

Design and participants: There were 1044 community-dwelling women in the Malmö Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 years).

Main outcome measures: PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality.

Results: At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., <6.9 pmol/L). Longitudinally, between ages 75 and 80 years, PTH increased in 60% of all women (n = 390) but increases of up to 50% above baseline values (64%; n=250) still resulted in PTH levels within the NRR. These women had lower 25OHD levels (74 vs 83 nmol/L, P = 0.001). Only when increases were >50% was PTH elevated beyond the NRR (mean 7.1 ± 3.3). Here, a pronounced decline in eGFR (56 vs 61 mL/min/1.73 m2, P = 0.002) was found, despite no further changes in 25OHD. Extending the observational period until age 85 years gave similar results. Baseline PTH levels above NRR were associated with mortality (hazard ratio, 1.4; 95% confidence interval (CI), 1.1-1.8; P = 0.007), although not after adjustment for covariates (P = 0.082).

Conclusions: Most women remained within normal PTH ranges despite large increases of up to 50%. PTH elevated above normal is not independently associated with mortality; impaired kidney function and low 25OHD status may be more prognostic in the very old.

Keywords: PTH; elderly women; kidney function; mortality; vitamin D.

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Figures

Figure 1.
Figure 1.
Elevated PTH above normal range (i.e., >6.9 pmol/L) was not associated with mortality after adjustment for covariates. (a) PTH measured at age 75 years; maximum follow-up 15 years: using Cox proportional hazards model, HRs were estimated comparing normal vs high PTH levels and adjusted for 25OHD, eGFR, phosphate, and smoking. (b) PTH measured at age 80 years; maximum follow-up 11 years: using Cox proportional hazards model, HRs were estimated comparing normal vs high PTH levels and adjusted for 25OHD, eGFR, phosphate, smoking, and comorbidities. Cum, cumulative.
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