Skip to main content
SpringerLink
Log in

Safety and efficacy of common vitamin D supplementation in primary hyperparathyroidism and coexistent vitamin D deficiency and insufficiency: a systematic review and meta-analysis

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Primary hyperparathyroidism (PHPT) is characterized by excessive secretion of parathyroid hormone (PTH). Vitamin D deficiency can stimulate parathyroid secretion. However, whether to correct vitamin D deficiency in patients with PHPT is controversial. We aimed to evaluate the safety and efficacy of vitamin D replacement in patients with PHPT.

Methods

We searched PubMed, Cochrane Library, and Embase. The relevant data were extracted from the included documents. The methodological items for non-randomized studies score entries were used for evaluation of quality. Review Manager 5.3 and Stata 12.0 were used for statistical analysis.

Results

A total of 11 articles were included with a total of 388 patients. The serum calcium mean difference (MD) was − 0.06 mg/dL [95% confidence interval (95% CI) − 0.16, 0.04]. Subgroup analysis showed that serum calcium levels did not change if the intervention time exceeded 1 month. The 24-h urinary calcium MD was 36.78 mg/day (95% CI − 37.15, 110.71), which indicated that there was no significant effect of vitamin D supplementation on 24-h urinary calcium levels. The MD of PTH was − 16.01 pg/mL (95% CI − 28.79, − 3.24). Subgroup analysis according to the intervention time showed that vitamin D intervention for more than 1 month significantly reduced PTH levels. The ALP MD was − 10.81 U/L (95% CI − 13.98, − 7.63), which indicated Vitamin D supplementation reduced its level. The MD of 25-hydroxyvitamin D was 22.09 μg/L (95% CI 15.01, 29.17), and no source of heterogeneity was found.

Conclusion

Vitamin D supplementation in patients with PHPT and vitamin D deficiency significantly reduces PTH and ALP levels without causing hypercalcemia and hypercalciuria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and material

The original data can be obtained by email request.

Code availability

Not applicable.

References

  1. Bandeira F, Griz L, Chaves N, Carvalho NC, Borges LM, Lazaretti-Castro M, Castro LC, Bilezikian J (2013) Diagnosis and management of primary hyperparathyroidism—a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism. Arq Bras Endocrinol Metabol 57:406–424

    Article  Google Scholar 

  2. Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806

    Article  CAS  Google Scholar 

  3. Wagner D, Xia Y, Hou R (2013) Safety of vitamin D replacement in patients with primary hyperparathyroidism and concomitant vitamin D deficiency. Endocr Pract 19:420–425

    Article  Google Scholar 

  4. Bilezikian JP (2000) Primary hyperparathyroidism. When to observe and when to operate. Endocrinol Metab Clin North Am 29:465–478

    Article  CAS  Google Scholar 

  5. Witteveen JE, Thiel S, Van Romijn JA, Hamdy NA (2013) Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol 168:R45-53

    Article  CAS  Google Scholar 

  6. Bevilacqua M, Invernizzi M, Righini V, Carda S, Cisari C (2011) Different vitamin D substrate-product relationship after oral vitamin D supplementation in familial benign hypercalcemia, primary hyperparathyroidism, and healthy controls. Eur J Endocrinol 64:833–838

    Article  Google Scholar 

  7. Das G, Eligar V, Govindan J, Bondugulapati LN, Okosieme O, Davies S (2015) Impact of vitamin D replacement in patients with normocalcaemic and hypercalcaemic primary hyperparathyroidism and coexisting vitamin D deficiency. Ann Clin Biochem 52:462–469

    Article  CAS  Google Scholar 

  8. Grey A, Lucas J, Horne A, Gamble G, Davidson JS, Reid IR (2005) Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab 90:2122–2126

    Article  CAS  Google Scholar 

  9. Grubbs EG, Rafeeq S, Jimenez C, Feng L, Lee JE, Evans DB, Perrier ND (2008) Preoperative vitamin D replacement therapy in primary hyperparathyroidism: safe and beneficial? Surgery 144:852–858

    Article  Google Scholar 

  10. Isidro ML, Ruano B (2009) Biochemical effects of calcifediol supplementation in mild, asymptomatic, hyperparathyroidism with concomitant vitamin D deficiency. Endocrine 36:305–310

    Article  CAS  Google Scholar 

  11. Kantorovich V, Gacad MA, Seeger LL, Adams JS (2000) Bone mineral density increases with vitamin D repletion in patients with coexistent vitamin D insufficiency and primary hyperparathyroidism. J Clin Endocrinol Metab 85:3541–3543

    CAS  PubMed  Google Scholar 

  12. LoCascio V, Adami S, Galvanini G, Ferrari M, Cominacini L, Tartarotti D (1985) Substrate-product relation of 1-hydroxylase activity in primary hyperparathyroidism. N Engl J Med 313:1123–1125

    Article  CAS  Google Scholar 

  13. Rao RR, Randeva HS, Sankaranarayanan S, Narashima M, Mohlig M, Mehanna H, Weickert MO (2012) Prolonged treatment with vitamin D in postmenopausal women with primary hyperparathyroidism. Endocr Connect 1:13–21

    Article  Google Scholar 

  14. Rathi MS, Gonzalez S, Wright D, Ellis NR, Peacey SR (2014) Management of hypovitaminosis D in patients with primary hyperparathyroidism. J Endocrinol Invest 37:467–471

    Article  CAS  Google Scholar 

  15. Tucci JR (2009) Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D. Eur J Endocrinol 161:189–193

    Article  CAS  Google Scholar 

  16. Loh HH, Lim LL, Yee A, Loh HS, Vethakkan SR (2019) Effect of vitamin D replacement in primary hyperparathyroidism with concurrent vitamin D deficiency: a systematic review and meta-analysis. Minerva Endocrinol 44:221–231

    Article  Google Scholar 

  17. Netelenbos JC, Asscheman H, Lips P, Van der Vijgh WJ, Jongen MJ, Van Ginkel F, Hackeng WH (1986) Absence of effect of 24,25-dihydroxyvitamin D3 in primary hyperparathyroidism. J Clin Endocrinol Metab 63:246–248

    Article  CAS  Google Scholar 

  18. Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P (2014) Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial. J Clin Endocrinol Metab 99:1072–1080

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Ellen Knapp, PhD, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This work was supported by the Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS-I2M), National Natural Science Foundation of China (No. 81100559).

Author information

Authors and Affiliations

  1. Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing, Beijing, 100730, China

    A. Song, Y. Yang, M. Nie, O. Wang & X. Xing

  2. Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050051, China

    H. Zhao

  3. Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China

    S. Liu

Authors
  1. A. Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Nie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. O. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. X. Xing
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AS and OW conceived the meta-analysis, AS and HZ searched the database, extracted information and data. YY and LS did statistical analysis. AS wrote the original manuscript. OW and XX edited drafts of the manuscript.

Corresponding authors

Correspondence to O. Wang or X. Xing.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethics approval

All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

Research involving Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent to participate

Not applicable.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (CSV 4 KB)

Supplementary file2 (DOCX 25 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, A., Zhao, H., Yang, Y. et al. Safety and efficacy of common vitamin D supplementation in primary hyperparathyroidism and coexistent vitamin D deficiency and insufficiency: a systematic review and meta-analysis. J Endocrinol Invest 44, 1667–1677 (2021). https://doi.org/10.1007/s40618-020-01473-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-020-01473-5

Keywords

Search

Navigation