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

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 less than 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 less than 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.