Well, at least part of the reason is the way we
define things (there are other reasons).
We define Vitamin D insufficiency as encompassing
around 40% of the population.
If we defined elevated PTH as being the top 40% of
the PTHs, then they would have elevated PTHs
(mostly).
Amongst the less important reasons are:
a) How do you know a "normal" PTH is not abnormal
for that person
b) How do you know the Vitamin D result is right?
c) Calcium supply is important - the slope of PTH
vs 25(OH)D will be steeper in folk with ca intake
= 600mg/day, and less steep (or even totally flat)
in those with much higher calcium supply.
Aubrey
DHT>
DHT> Dear Clement
DHT>
DHT> If not all subjects with vitamin D
DHT> deficiency/insufficiency have a raised PTH
DHT> can I ask if we know why not? I could think
DHT> of co-existing hypomagnesaemia as a
DHT> possibility but that was about the extent of it.
DHT>
DHT> Best wishes
DHT>
DHT>
DHT> Dave Hullin
DHT>
DHT>
DHT>
DHT> Dr D A Hullin
DHT>
DHT> Department of Clinical Biochemistry
DHT>
DHT> Royal Glamorgan Hospital
DHT>
DHT> Llantrisant
DHT>
DHT> Rhondda-Cynon-Taff
DHT>
DHT> CF72 8XR
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT> From: Clinical biochemistry discussion list
DHT> [mailto:[log in to unmask]] On
DHT> Behalf Of Ho Clement (NHS Highland)
DHT> Sent: 24 November 2009 11:42
DHT> To: [log in to unmask]
DHT> Subject: Re: Assessment of vitamin D status
DHT>
DHT>
DHT>
DHT>
DHT>
DHT> Not all patients who are vitamin D deficient
DHT> have raised PTH levels. Therefore, PTH within
DHT> the reference interval cannot exclude vitamin
DHT> D deficiency or insufficiency.
DHT>
DHT>
DHT>
DHT>
DHT> Best wishes,
DHT>
DHT>
DHT>
DHT> Clement
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT> From: Clinical biochemistry discussion list
DHT> [[log in to unmask]] On Behalf
DHT> Of Myers Martin (LTHTR)
DHT> [[log in to unmask]]
DHT> Sent: 24 November 2009 11:21
DHT> To: [log in to unmask]
DHT> Subject: Assessment of vitamin D status
DHT>
DHT>
DHT>
DHT>
DHT>
DHT>
DHT> Apologies for this relatively simple
DHT> question, but it is causing debate locally.
DHT>
DHT> In "mild" Vitamin D deficiency (25-50
DHT> nmol/L) should PTH be measured before starting treatment?
DHT>
DHT> Martin
DHT>
DHT>
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Regards
Aubrey Blumsohn
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