Serum immunoreactive parathyroid hormone and 25-hydroxyvitamin D in patients with uremic bone diseases

Bone histologic parameters and serum iPTH and 25-OHD were measured in 20 patients with end-stage renal failure treated with hemodialysis. By bone histologic criteria, the patients were divided into three groups: mild, osteomalacic, and fibrotic. The increase in serum iPTH was much greater in the fibrotic group than in the mild or osteomalacic groups. In the uremic patients as a group, there were significant correlations between serum iPTH and both percent marrow fibrosis and percent resorbing surface. In the mild and fibrotic groups together, serum iPTH was also correlated with percent forming surface. This and other findings suggested that most of the bone changes in the mild and fibrotic groups could be explained by excess PTH. The difference in bone changes and in serum iPTH between the mild and fibrotic groups could be related to our eariler findings that duration of renal disease was much greater in the fibrotic than in the mild group. The lowest increment in serum iPTH was found in the osteomalacic group. In this group, percent resorbing surface was not increased and there was only a slight increase in marrow fibrosis. Thus in all three groups, serum iPTH appeared to reflect parathyroid status. The cause of the elevated serum iPTH and for the intergroup differences was not apparent inasmuch as serum calcium was normal in all three groups. Serum 25-OHD was significantly elevated in the osteomalacic and fibrotic groups. Because none of our patients had received preparations containing vitamin D, the elevated serum 25-OHD in the osteomalacic and fibrotic groups is consistent with altered vitamin D metabolism in these two groups. There was a direct relationship between percent osteroid area and serum 25-OHD. However, whether or not altered vitamin D metabolism contributed to the mineralization defect in uremic bone disease could not be established.