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2800 IU of vitamin D before and after parathyroid surgery helped a lot – RCT Jan 2014

Vitamin D Treatment in Primary Hyperparathyroidism: a Randomized Placebo Controlled Trial.

J Clin Endocrinol Metab. 2014 Jan 13:jc20133978.
Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P.
Department of Surgery P, Breast and Endocrine Section, THG, Aarhus University Hospital, Denmark

Context: Low 25-hydroxy vitamin D (25OHD) levels are common in patients with primary hyperparathyroidism (PHPT) and associated with higher PTH levels and hungry bone syndrome following parathyroidectomy (PTX). However, concerns have been raised on safety of vitamin D supplementation in PHPT.

Objective: We aimed to assess safety and effects on calcium homeostasis and bone metabolism of supplementation with high doses of vitamin D in PHPT patients.

Design, Setting: This was an investigator-initiated double-blind, randomized, placebo-controlled, parallel-group trial from a single center.

Patients: Forty-six PHPT patients were recruited, mean age of 58 (range 29-77) years and 35 (76%) were women. Interventions: Daily supplementation with 70 microgram (2800 IU) cholecalciferol or identical placebo for 52 weeks. Treatment was administered 26 weeks prior to PTX and continued for 26 weeks after PTX.

Main Outcome Measures: PTH, calcium homeostasis, and bone metabolism.

Results: Preoperatively, 25OHD

  • increased from 50 to 94 nmol/L in the treatment group and
  • decreased from 57 to 52 nmol/L in the placebo group (p<0.001).

Compared with placebo, vitamin D decreased PTH significantly by 17% prior to PTX (p=0.01), lumbar spine BMD increased by 2.5% (p=0.01), and CTx decreased by 22% (p<0.005). Trabecular bone score did not change in response to treatment, but improved following PTX.

Postoperatively, PTH remained lower in the cholecalciferol group compared with the placebo group (p=0.04). Plasma creatinine and plasma and urinary calcium did not differ between groups.

Conclusions: Daily supplementation with a high vitamin D dose safely improves vitamin D status and decreases PTH in PHPT patients. The vitamin D treatment is accompanied with reduced bone resorption and improved BMD before operation.

PMID: 24423366

See also VitaminDWiki