Deficient production of 1,25-dihydroxyvitamin D in elderly osteoporotic patients

Author(s): Slovik DM, Adams JS, Neer RM, Holick MF, Potts JT


There is uncertainty about the adequacy of renal secretion of 1,25-dihydroxyvitamin D (1,25-(OH)2-D) in elderly patients with osteoporosis. To investigate this uncertainty, we stimulated secretion of 1,25-(OH)2-D with a 24-hour intravenous infusion of synthetic human parathyroid hormone fragment 1–34 and compared the results in normal young adults and elderly patients with untreated osteoporosis. Serum levels of 1,25-(OH)2-D were similar in both groups (49±10 and 42±9 pg per milliliter [116±24 and 99±21 pmol per liter]) before the infusion. However, during the 24-hour infusion, serum levels nearly doubled (P<0.01) in the normal volunteers but did not change significantly in the patients. Serum ionized calcium increased and serum inorganic phosphate decreased similarly in both groups during the infusion (P<0.05). Although the present study does not establish whether deficient 1,25-(OH)2-D secretory reserve is an effect of age or of osteoporosis, it is possible that such a deficiency will explain the inability of elderly osteoporotic patients to adapt to the low-calcium diets common in this age group. If so, this phenomenon may play a part in the pathogenesis of age-related osteoporosis. (N Engl J Med. 1981; 305:372–4.)

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