Tibial Tenderness Identifies Secondary Hyperparathyroidism Responding to High Dose Vitamin D in Pakistani Women.
Endocr Pract. 2013 Feb 20:1-20.
Ali B, Butt A, Fatima A, McDonnell ME, Masud F.; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Objectives: To assess the utility of anterior tibial tenderness (ATT) measured by visual analogue score (VAS) as a clinical diagnostic tool for vitamin D deficiency in a high-risk population of Pakistani women
Methods: ATT using a VAS was assessed in 75 premenopausal women, ages 17-56 (mean 41.3) with generalized aches and pains and calcium of less than 11.0mg/dl (normal: 8-11) at a tertiary care center in Lahore, Pakistan. This was followed by administration of 1.8 million units of vitamin D3 in divided doses. ATT, vitamin D and parathyroid hormone (PTH) levels were checked before and after the injections. Correlation between ATT, vitamin D and PTH as well as change in ATT, vitamin D and (PTH) following supplementation was determined.
Results: Pre-intervention average calcium and vitamin D were 9.3mg/dl (8-10.3) and 12.1 ng/ml (1.5-32.6) respectively. 74% (53/75) of the participants had vitamin D deficiency and elevated PTH (>60).
Mean PTH was 81.6pg/ml (29.1-370).
Change in ATT correlated strongly (r=0.422, p=0.013) with change in PTH.
Following supplementation, there was significant improvement in ATT (p<0.01), and vitamin D levels (p<0.01), with a decrease in PTH levels (p<0.01).
Conclusions: Anterior tibial tenderness is a valid clinical diagnostic tool for vitamin D deficiency in South Asian women.
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