The role of vitamin D and parathyroid hormone in the osteoporosis in spinal cord injury

M. Bystrytska


Background. Osteoporosis and vitamin D deficiency are known complications of spinal cord injury (SCI). The role of vitamin D and parathyroid hormone (PTH) in the SCI­induced osteoporosis remain controversial. The purpose of the study was to determine the vitamin D and PTH levels and its relationship with bone loss in SCI persons. Materials and methods. Sixty­nine SCI persons and 43 people of the corresponding age and gender in the comparison group were examined. The levels of vitamin D, PTH as well as bone resorption marker (β­CTx) were determined using the electrochemiluminescent method. Bone loss was examined by dual­energy X­ray absorptiometry and ultrasound (US) densitometry of the calcaneus. Results. The vitamin D level in SCI persons was significantly lower than in the comparison group (12.7 ± 8.9 versus 24.6 ± 9.8 ng/ml; t = 6.6; p < 0.0001). The PTH, calcium and phosphorus levels did not differ. The vitamin D level decreased significantly and PTH increased significantly with the increase of SCI duration. The PTH also increased significantly with a decrease in the vitamin D level. There was no correlation between the level of vitamin D and the bone parameters. However, a positive correlation was found between the PTH level and the calcaneus Z­index in chronic SCI (over 5 years), as well as a significant negative correlation between the bone resorption markers (β­CTx) and PTH. Conclusions. Low PTH level, rather than elevated level indicates increased bone resorption and can be considered as a risk factor for SCI­induced osteoporosis.


osteoporosis; vitamin D; parathyroid hormone; spinal cord injury


Hammond ER , Metcalf HM, McDonald JW, Sadowsky CL. Bone mass in individuals with chronic spinal cord injury: associations with activity-based therapy, neurologic and functional status, a retrospective study. Arch Phys Med Rehabil. 2014; 95(12):2342-9. doi: 10.1016/j.apmr.2014.07.395.

Abderhalden L , Weaver FM, Bethel M. et al. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders. Osteoporos Int. 2017; 28(3):925-934. doi: 10.1007/s00198-016-3841-y.

Lamarche J , Mailhot G, Vitamin D and spinal cord injury: should we care? Spinal Cord. 2016; 54(12):1060-1075. doi: 10.1038/sc.2016.131.

Doubelt I, de Zepetnek JT, MacDonald MJ, Atkinson SA. Influences of nutrition and adiposity on bone mineral density in individuals with chronic spinal cord injury: A cross-sectional, observational study.Bone Reports. 2015; 2: 26–31. doi: 10.1016/j.bonr.2015.02.002

Povoroznyuk VV, Balatska NI. Vitamin D deficiency in the population of Ukraine and the risk factors for its development. Pain. Joints. Spine. 2012; 4 (08):5–11. (In Ukrainian).

Pritchett K, Pritchett R, Ogan D, Bishop P, Broad E, LaCroix M. 25(OH)D Status of Elite Athletes with Spinal Cord Injury Relative to Lifestyle Factors. Nutrients. 2016;8(6), 374. .

Gaspar AP, Brandao CM, Lazaretti-Castro M. Bone mass and hormone analysis in patients with spinal cord injury: evidence for a gonadal axis disruption. J Clin Endocrinol Metab. 2014; 99: 4649–4655. doi: 10.1210/jc.2014-2165.

Nemunaitis GA, Mejia M, Nagy JA, Johnson T, Chae J, Roach MJ. A descriptive study on vitamin D levels in individuals with spinal cord injury in an acute inpatient rehabilitation setting. PM R. 2010; 2: 202–208. doi: 10.1016/j.pmrj.2010.01.010.

Karapolat I, Karapolat HU, Kirazli Y, Capaci K, Akkoc Y, Kumanlioglu K. Longitudinal study of bone loss in chronic spinal cord injury patients. J Phys Ther Sci. 2015; 27: 1429–1433. doi: 10.1589/jpts.27.1429

Ritter CS, Brown AJ. Direct suppression of Pth gene expression by the vitamin D prohormones doxercalciferol and calcidiol requires the vitamin D receptor. J Mol Endocrinol. 2011; 46: 63–66.  doi: 10.1677/JME-10-0128

Ceglia L, Harris SS. Vitamin D and its role in skeletal muscle. Calcif Tissue Int. 2013; 92: 151–162. doi: 10.1007/s00223-012-9645-y

Harlow L, Sahbani K, Nyman JS, Cardozo CP, Bauman WA. Tawfeek HA. Daily parathyroid hormone administration enhances bone turnover and preserves bone structure after severe immobilization induced bone loss. Physiological Reports. 2017;5(18), e13446.

Flueck JL , Perret C. Vitamin D deficiency in individuals with a spinal cord injury: a literature review. Spinal Cord. 2017;55(5):428–434. doi: 10.1038/sc.2016.155.

Hummel K, Craven BC, Giangregorio L. Serum 25(OH)D, PTH and correlates of suboptimal 25(OH)D levels in persons with chronic spinal cord injury. Spinal Cord.2012; 50: 812–816. doi: 10.1038/sc.2012.67

Barbonetti A, Sperandio A, Micillo A, D'Andrea S, Pacca F, Felzani G et al.Independent association of vitamin D with physical function in people with chronic spinal cord injury.Arch Phys Med Rehabil. 2016; 97: 726–732. doi: 10.1016/j.apmr.2016.01.002

Bauman WA, Korsten MA, Radulovic M, Schilero GJ., Wecht JM, Spungen AM. 31st G. Heiner Sell Lectureship: Secondary Medical Consequences of Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2012;18(4): 354–378.

Barbonetti A, Vassallo MR, Felzani G, Francavilla S, Francavilla F. Association between 25(OH)-vitamin D and testosterone levels: evidence from men with chronic spinal cord injury. J Spinal Cord Med. 2015; 39: 246–252.

Copyright (c) 2018 TRAUMA

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта