Vitamin D, parathyroid hormone, and acroosteolysis in systemic sclerosis.

Abstract

OBJECTIVE:

.Sclerodactyly with acroosteolysis (AO) and calcinosis are prominent features of systemic sclerosis (SSc), but the pathogenesis of these findings is poorly understood. Vitamin D and parathyroid hormone (PTH) have a crucial role in bone metabolism and resorption and may affect AO and calcinosis. We assessed vitamin D and PTH in patients with SSc.

METHODS:

Medical records of 134 consecutive patients with SSc (American College of Rheumatology criteria) followed at the rheumatology department during the years 2003-2006 were reviewed for clinical assessment, laboratory evaluation [including 25(OH) vitamin D, calcium, phosphorus, alkaline phosphatase, PTH, creatinine, and albumin]; imaging data confirming AO and/or calcinosis. Patients followed routinely at least once a year were included (81 patients). Of these, 60 patients' medical records were found to have complete, relevant clinical, laboratory, and radiographic imaging.

RESULTS:

Thirteen patients had diffuse disease and 47 limited disease - 51 women and 9 men, 44 Jews and 16 Arabs; mean age 55 +/- 14 years; disease duration 8 +/- 6 years. AO with or without calcinosis was observed in 42 patients (70%). Vitamin D deficiency was found in 46% of patients (16 out of 44 Jewish patients, 10 out of 16 Arab patients). PTH was elevated in 21.7% of patients. Significant correlations were observed between acroosteolysis and PTH (p = 0.015), calcinosis (p = 0.009), and disease duration (p = 0.008), and between PTH and vitamin D levels (p = 0.01). All patients had normal serum concentrations of calcium, phosphorus, magnesium, and albumin, and liver and kidney functions.

CONCLUSION:

In this group of Mediterranean patients with SSc, the incidence of vitamin D deficiency and secondary hyperparathyroidism was surprisingly high. This finding correlated with the occurrence of AO and calcinosis. Low levels of vitamin D may reflect silent malabsorption and might be a risk factor for secondary hyperparathyroidism and bone resorption. Traditional dress habits and low exposure to sun may contribute to vitamin D deficiency in an Arab population but do not explain all the findings. The pathogenesis of these findings needs to be corroborated in other SSc populations.

• Authors: Yolanda Braun-Moscovici, Daniel E Furst, Doron Markovits, Alexander Rozin, Philip J Clements, Abraham Menahem Nahir, Alexandra Balbir-Gurman
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 35 Issue 11 Pg. 2201-5 (Nov 2008) ISSN: 0315-162X [Print] Canada
• PMID: 18843781 (Publication Type: Journal Article)

Chemical References

• Parathyroid Hormone
• Vitamin D

Topics

• Acro-Osteolysis (diagnostic imaging, epidemiology, metabolism)
• Adult
• Aged
• Arabs (statistics & numerical data)
• Female
• Humans
• Hyperparathyroidism, Secondary (diagnostic imaging, epidemiology, metabolism)
• Incidence
• Jews (statistics & numerical data)
• Male
• Mediterranean Region (epidemiology)
• Middle Aged
• Parathyroid Hormone (blood)
• Prevalence
• Radiography
• Risk Factors
• Scleroderma, Systemic (diagnostic imaging, epidemiology, metabolism)
• Vitamin D (blood)
• Vitamin D Deficiency (diagnostic imaging, epidemiology, metabolism)