Tibial Tenderness Identifies Secondary Hyperparathyroidism Responding to High-Dose Vitamin D in Pakistani Women |
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| Institution: | 1. Department of Medicine, Harvard Medical School, Boston, Massachusetts;2. Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan;3. Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore, Pakistan;4. Department of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts;1. The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, the;2. Department of Obstetrics, Gynecology & Women’s Health, John A. Burns School of Medicine, University of Hawaii, the;3. Kuakini Medical Center, and the;4. Miki Medical Associates, Honolulu, Hawai.;1. Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts;2. Case Western Reserve University School of Medicine, Cleveland, Ohio;3. Boston University School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Boston, Massachusetts.;1. Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy;2. Endocrine Unit and Thyroid Diseases Center, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia;3. Department of Endocrinology and Metabolism, Thessaloniki, Greece;4. Department of Pathology,“V. Fazzi” Hospital, Lecce, Italy;5. Institute of Pathology, Locarno, Switzerland;6. Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;7. Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;1. Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India;2. Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.;3. DDepartment of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India;4. Department of Surgical Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.;1. Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Local Health Board, Merthyr Tydfil, Mid Glamorgan, CF47 9DT, UK;1. Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio;2. Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio |
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| Abstract: | ObjectiveTo assess the utility of anterior tibial tenderness (ATT) measured by visual analogue scoring (VAS) as a clinical diagnostic tool for vitamin D deficiency in a high-risk population of Pakistani women.MethodsATT was measured by VAS in 75 premenopausal women age 17 to 56 years (mean, 41.3 years) with generalized aches and pains and calcium <11 mg/dL (normal, 8 to 11 mg/dL) who were seen at a tertiary care center in Lahore, Pakistan. This was followed by administration of 1.8 million units of vitamin D3 in divided doses. ATT, vitamin D, and parathyroid hormone (PTH) levels were checked before and after the injections. Correlation between ATT, vitamin D, and PTH, as well as changes in ATT, vitamin D, and PTH following supplementation were determined.ResultsPre-intervention average calcium and vitamin D were 9.3 mg/dL (range, 8 to 10.3 mg/dL) and 12.1 ng/mL (range, 1.5 to 32.6 ng/mL), respectively. Seventy-four percent of the participants (53/75) had vitamin D deficiency and elevated PTH (>60 pg/mL). Mean PTH was 81.6 pg/mL (range, 29.1 to 370 pg/mL). Changes in ATT correlated strongly (r = 0.422; P = .013) with changes in PTH. Following supplementation, there was significant improvement in ATT (P<.01) and vitamin D level (P<.01), with a decrease in PTH level (P<.01).ConclusionATT is a valid clinical diagnostic measure of vitamin D deficiency in South Asian women. (Endocr Pract. 2013;19:596-601) |
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