Vol. 11, Issue 1, June 2015.



Tatjana Milivojac1, Nela Rašeta1, Vera Aksentić2, and Milkica Grabež1

1School of medicine, University of Banja Luka, Bosnia and Hrezegovina
Institute of Physical Medicine and Rehabilitation “Dr Miroslav Zotović”, Banja Luka, Bosnia and Herzegovina

doi: 10.5550/sgia.151101.en.002M
UDC: 618.173:577.161.2



FULL TEXT (.pdf)

The primary role of vitamin D is regulation of calcium, phosphorus and bone metabolism. Vitamin D status assessment is based on measuring of 25 (OH) D concentrations, and disorders of vitamin D status may be manifested as a vitamin D insufficiency, vitamin D deficiency and vitamin D hypervitaminosis. It is generally accepted that values above 75 nmol / L will suffice to prevent the occurrence of secondary hyperparathyroidism. Although vitamin D deficiency can be found at any age, it is most common in women with postmenopausal osteoporosis, and in older women. The aim of this study was to determine the vitamin D status, parathyroid hormone levels and calcium levels in women with newly diagnosed postmenopausal osteoporosis, and to compare the results with the same parameters observed and measured in women without osteoporosis, and to establish whether there is a connection between vitamin D levels and levels of other parameters. The study involved 85 postmenopausal women, all of which were screened for osteoporosis by measuring bone mineral density in the lumbar spine and hip region using DXA method. Of these, 50 women were found to have osteoporosis while 35 had regular DXA values. Our results showed a high incidence of vitamin D deficiency in postmenopausal women, with significantly higher vitamin D deficiency in women with osteoporosis. The values of parathyroid hormone were higher, and the values of ionized calcium were lower in women with osteoporosis, and there is a negative correlation between 25 (OH) D and parathyroid hormone. The most common risk factors for osteoporotic fracture in postmenopausal women were early menopause and previous fracture in adulthood. Reduced levels of vitamin D in women with postmenopausal osteoporosis leads to changes in calcium and parathyroid hormone metabolism.

Key words:parathyroid hormone, postmenopausal osteoporosis, Vitamin D.


Aloia, J. F.  (2001). Optimal vitamin D status and serum parathyroid hormone. Br J Nutr, 86(1), 97–103.
Aloia, J. F., Feuerman, M., & Yeh, J. K. (2006). Reference Range for serum Parathyroid Hormone. Endocrine Practice Journal- American Association of Clinical Endocrinologists, 12(2), 137–144. doi: 10.4158/EP.12.2.137; PMid: 16690460; PMCid: PMC1482827
Aloia, J. F., Talwar, S. A., Pollack, S., Feuerman, M., & Yeh, J. K. Optemal vitamin D status and serumparathyroid hormone concentrations in African American women. Am J Clin Nutr, 84(3), 602–609.
Anđelković, Z. (2009). Značaj određivanja statusa vitamina D u posmenopauzalnoj osteoporozi [The significance of the status of vitamin D in postmenopause osteoporosis]. Balneoclimatologija, 33(4), 3–9.
Avenell, A., Mak, J. C., & O'Connell, D. (2014). Vitamin D and Vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev., 4: CD000227.
doi: 10.1002/14651858.cd000227.pub4
Bischoff-Ferrari, H. A., Dawson Hughes, B., Willet, W. C., Staehelin, H. B., Bazemore, M. G., Zee, R. Y., & Wong, J. B. (2004). Effect of vitamin D on falls. JAMA, 291(16), 1999–2006. doi: 10.1001/jama.291.16.1999; PMid: 15113819
Bischoff-Ferrari, H. A., Willett, W. C., Wong, J. B., Giovannucci, E., Dietrich, T., & Dawson-Hughes, T. (2005). Fracture prevention with vitamin D supplementation: a metaanalysis of randomized clinical trials. JAMA, 293(18), 2257–2264. doi: 10.1001/jama.293.18.2257; PMid: 15886381
Bronner, F. (2001). Extracellular and intracellular regulation of calcium homeostasis. Sci World J, 1, 919–925.
doi: 10.1100/tsw.2001.489; PMid: 12805727
Brixen, K., Abrahamsen, B., & Kassem, M. (2005).Prevention and treatment of osteoporosis in women. Current Obstetrics & Gynaecology, 15, 251–258. doi: 10.1016/j.curobgyn.2005.05.003
Canalis, E. (2010). Update in new anabolic therapies for osteoporosis. J Clin Endocrinol Metab, 95(4), 1496–1504. doi: 10.1210/jc.2009-2677; PMid: 20375217; PMCid: PMC2853988
Cooper, A. L. (2006). Improved patient persistence on once-monthly dosing regime plus patient support compared with a weekly dosing regime Abstract P798MO. In IOF World Congress on Osteoporosis. Toronto, Canada.
Cosman, F., deBeur, S. J., LeBoff, M. S.. Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinical GUide to Prevention and Treatment of Osteoporosis. Osteoporosis Int, 25, 2359–2381.
doi: 10.1007/s00198-014-2794-2; PMid: 25182228 ;PMCid: PMC4176573
Cumming, R. G., & Nevitt, M. C. (1997). Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res, 13, 1530–1538. doi: 10.1359/jbmr.1997.12.9.1321
Ćirković, M., Petronijević, M., Ristić, G., Glišić, B., & Stefanović, D. (2010). Značaj određivanja koncentracije vitamina D u prevenciji preloma kod postmenopauzalnih žena [The significance of determining the concentration of vitamin D in the prevention of fractures in postmenopausal women]. Acta Rheumatologica Belgradensia, 40(2), 124 Daniel, H. W. (1972). Osteoporosis and smoking. JAMA, 221-240. doi: 10.1001/jama.1972.03200180051022;
doi: 10.1001/jama.221.5.509b
Dawson-Hughes, B., Heaney, R. P., Holick, M. F., Lips, P., Meunier, P. J., & Vieth, R. (2005). Estimates of optimal vitamin D status. Osteoporosis Int, 16(7), 713–716. doi: 10.1007/s00198-005-1867-7; PMid: 15776217
Deng, H., Chen, W., Conway, T., Zhou, Y., Daves, K. M., Stegman, M. R., ... Recker, R. R. (2000).Determination of bone mineral density of the hip and spine in human pedigrees by genetic and life-style factors. Genetic Epidemiology, 19, 160–167. doi: 10.1002/1098-2272(200009)19:2<160::AID-GEPI4>3.0.CO;2-H
Ettinger, P. M. (2003). Aging bone and osteoporosis. Archives of Internal Medicine, 163(18), 2237–2246.
doi: 10.1001/archinte.163.18.2237; PMid: 14557222
Feskanich, D., Willett, W., & Colditz, G. (2002).Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA, 288(18), 2300-2306. doi: 10.1001/jama.288.18.2300; PMid: 12425707
Grand, A. M., Avenell, A., Campbell, M. K., McDonald, A. M., MacLennan, G. S., McPherson, G. C., ... Wallace, W. A. (2005). Oral vitamin D3 and calcium for secondary prevention of low trauma fractures in elderly people (Randomised Evaluation of Calcium or Vitamin D, RECORD): A randomised placebo-controlled trial. Lancet, 365(9471), 1621–1628. doi: 10.1016/S0140-6736(05)63013-9
Greiwe, J. S., Cheng, B., Rubin, D. C., Yarasheski, K. E., & Semenkovch, C. F. (2001). Resistance exercise decreases skeletal muscle tumor necrosis factor in frail elderly humans. FASEB J, 15(2), 475–482.
doi: 10.1096/fj.00-0274com; PMid: 11156963
Holick, M. F. (2007). Vitamin D deficiency. N Engl J Med, 357(3), 266–281. doi: 10.1056/NEJMra070553; PMid: 17634462
Iqbal, M. M. (2000). Osteoporosis: epidemiology, diagnosis and treatment. South Med J, 93, 2–18.
doi: 10.1097/00007611-200001000-00001; doi: 10.1097/00007611-200093010-00002; PMid: 10653058
Jackson, R. D., LaCroix, A. Z., Gass, M. Wallace, R. B., Robbins, J., Lewis, C. E., ... Barad, D. (2006). Calcium plus vitamin D supplementation and risk of fractures. N Engl J Med, 354, 669–683. doi: 10.1056/NEJMoa055218; PMid: 16481635
Jovičić, S., Ignatović, S., Beletić, A., Mirković, D., & Majkić-Singh, N. (2012). Poređenje tri različite metode za određivanje 25(OH)D i statusa vitamina D u opštoj populaciji [Comparison of three different methods for the determination of 25 (OH) D and vitamin D status in the general population]. Journal of Medical Bichemistry; 31(4), 347–357.
Kanis, J. A., Olden, A., Johansson, H., Borgstrom, F., Storm, O., & McCloskey, E. (2009). FRAX its applications to clinical practice. Bone, 44(5), 734–743. doi: 10.1016/j.bone.2009.01.373; PMid: 19195497
Kuchuk, N. O., van Schoor, N. M., Pluim, S. M., Chines, A., & Lips, P. (2009). Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective. J Bone Mener res, 24(4), 693–701. doi: 10.1359/jbmr.081209; PMid: 19049341
Lanyon, L., & Skerry, T. (2001). Postmenopausal osteoporosis as a failure of bone's adaptation to functional loading: a hypothesis. J Bone Miner Res., 16(11), 1937–1947. doi: 10.1359/jbmr.2001.16.11.1937; PMid: 11697789
Lips, P. (2006). Vitamin D physiology. Prog Biophys Mol Biol, 92(1), 4–8. doi: 10.1016/j.pbiomolbio.2006.02.016; PMid: 16563471
Lips, P., Hosking, D., Lippuner, K., Norquist, J. M., Wehren, L., Maalouf, G., ... Chandler, J. (2006). The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med, 260, 245–254. doi: 10.1111/j.1365-2796.2006.01685.x; PMid: 16918822
McCloskey, E. (2006). Using risk factors for diagnosis ond treatment of osteoporosis. Osteoporosis Int, 17(12), 112–115.
Morris, H. A., & Anderson, P. H. (2010). Autocrine and paracrine action of Vitamin D. Clin Biochem Rev, 31(4), 129–138. PMid: 21170259; PMCid: PMC2998276
National Osteoporosis Foundation. (2003). Physicians guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation (NOF).
National Osteoporosis Foundation. (2015). Interdisciplinary symposium on osteoporosis. Washington, DC: National Osteoporosis Foundation (NOF).
Nuti, R., Bianchi, G., Brandi, M. L., Caudarella, R., Derasmo, E., Fiore, C., ... Ortolani, S. (2009). Superiority of alfacalcidol compared to vitamin D plus calcium in lumbal bone mineral density in postmenopausal osteoporosis. Rheumatol Int, 26(5), 445–453. doi: 10.1007/s00296-005-0073-4; PMid: 16283320
Outila, T. A., Kärkkäinen, M. U., & Lamberg-Allardt, C. J. (2001). Vitamin D status affects serum concentrations during winter in female adolescents: associations with forearm BMD. Am J Clin Nutr, 74(2), 206–210. PMid: 11470722
Owen, T. A., Aronow, M. S., Barone, L. M., Stein, G. S., & Lian, J. B. (1991). Pleiotropic effects of vitamin D on osteoblast gene expression are related to proliferative and differentiated state of the bone cell phenotype: dependency upon basal levels of gene expression, duration of exposure, and bone matrix competency in normal rat osteoblast cultures. Endocrinology, 128, 1496–1504. doi: 10.1210/endo-128-3-1496; PMid: 1999168
Richard, J. B, Rivadeneira, F., Inouye, M., Pastinen, T. M., Soranzo, N., Wilson, S. G. ... Hart, P. (2008). Bone mineral density, osteoporosis and osteoporotic fractures: a genome wide association study. Lancet; 371(9623), 1505–1512. doi: 10.1016/S0140-6736(08)60599-1
Panneman, M. J., Lips, P., Sen, S. S., & Herings R. M. (2004). Undertreatment with anti osteoporotic drugs after hospitalsation for fracture. Osteoporosis Int, 15(2), 120–124. doi: 10.1007/s00198-003-1544-7; PMid: 14618302
Peacock, M., Selby, P. L., Francis, R. M., Brown, W. B., & Hordon, L. (1985). Vitamin D deficiency, insufficiency, sufficiency and intoxication. What do they mean?. In A.W. Norman, K. Schaefer, H. G. Grigoleit, & D. V. Herrath (Eds.), Vitamin D: Chemical, biochemical and clinical update (pp. 569–570). Berlin, Germany: Walter de Gruyter.
Peluso, M. A., & Guerra de Andrade, L. H. S. (2005). Physical activity ond mental haelth: the assotiation betveen exercise and mood. Clinics., 60(1), 61–70. doi: 10.1590/S1807-59322005000100012; PMid: 15838583
Pilipović, N., Branković, S., & Vujasinović, N. (2005). Koštana masa i prelomi kostiju kod stanovnika Beograda [Bone mass and bone fractures in the population of Belgrade]. Acta Rheum Belgr, 35(1), 35–39.
Recker, R. R., Stakkestad, J. A., Chesnut, C. H., Christiansen, C., Skag, A., Hoiseth, A., ... Delmas, P. D. (2004). Insufficiently dose intravenous ibandronate injections are associated with suboptimal antifracture efficacy in postmenopausal osteoporosis. Bone, 34(5), 890–899. doi: 10.1016/j.bone.2004.01.008; PMid: 15121021
Roodman, G. D. (1999). Cell biology of the osteoclast. Exp Hemat, 27(8), 1229–1231.
doi: 10.1016/S0301-472X(99)00061-2
Sempos, C. T., Vesper, H. W., Phinney Thienpont, L. M., & Coates, P. M. (2012). Vitamin D status as an international issue: National surveysand the problem standardization. Scand J Clin Lab Invest, 243, 32–40.
Shoback, D., Marcus, R., Bikle, D., & Strewler, G. J. (2001). Mineral metabolism and metabolic bone disease. In F. S. Greenspan & D. G. Gardner (Eds.), Basic and Clinical Endocrinology (pp 485–493). New York, NY: McGraw–Hill.
Siris, S. E. (2004). Bone health menopause: Assessing who is at risk of developing osteoporosis. In Satellite Symposium at IOF World Congress on Osteoporosis (pp. 7–8). Rio De Janeiro, Brazil: International Osteoporosis Foundation.
Sornay-Rendy, E., Munoz, F., Garnero, P., & Delmas, P. D. (2005). Identification of osteopenic women at high risk of fracture: The OFELY study. J Bone Mener Res, 20(10), 1813–1819. doi: 10.1359/JBMR.050609; PMid: 16160738
Souberbielle, J. C., Cormier, C., Kindermans, C, Gao, P., Cantor, T., Forette, T., & Baulieu, E. E. (2001). Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab., 86(7), 3086–3090. doi: 10.1210/jcem.86.7.7689; doi: 10.1210/jc.86.7.3086; PMid: 11443171
Souberbielle, J. C., Lawson-Body, E., Hammadi, B., Sarfati, E., Kahan, A., & Cormier, C. (2003). The use in clinical practice of parathyroid hormone normative values established in vitamin D-sufficient subjects. J Clin Endocrinol Metab., 88(8), 3501–3504. doi: 10.1210/jc.2003-030097; PMid: 12915625
Stefanović, D., Zečević, R., & Petronijević, M. (2009). Vitamin D i analozi za zdrave kosti, za zdrav život [Vitamin D and analogues for healthy bones, for healthy life]. Belgrade, Serbia: Actavis trading.
Stevenson, J. C., & Marsh, M. S. (2007). An atlas of osteoporosis. 3rd edition. London, Unred Kngdom: Informa UK Ltd. doi: 10.3109/9780203090848
Sweet, M. G., Jeremiah, M. P., & Galazka, S. S. (2009).Diagnosis and treatment of osteoporosis. Am Fam Physician, 79(3), 193–200. PMid: 19202966
Trivedi, D., Doll, R., & Khaw, E. (2003). Effects of fourly oral vitamin D supplementation on fractures ond mortality in men and women living in the community: randomised double blind controlled trial. BMJ, 326(7387), 469–475.
doi: 10.1136/bmj.326.7387.469; PMid: 12609940; PMCid: PMC150177
Tuck, S. P., & Francis, R. M. (2002). Osteoporosis. Postgrad Med J, 78(923), 526–532.
doi: 10.1136/pmj.78.923.526
; PMid: 12357012; PMCid: PMC1742482
Vieth, R, & Fraser, D. (2002). Vitamin D insufficiency: No RDA exists for this nutrient. Can Med Assoc J, 166(12), 1541–1542.
WHO. (1994). Study Group on assessment of fracture risk and application to screening for postmenopausal osteoporosis. Report of WHO study group. Geneva, Switzerland: WHO Technical Report Series, 1-129.
Weaver, C. M. (2015). Parellels between nutrition and physical activity: research  questions in development of peak bone mass. Res Q Exerc Sport, 86(2), 103–106. doi: 10.1080/02701367.2015.1030810; PMid: 25965111
Winsloe, C., Earl, S., Dennison, E. M., Cooper, C., & Harvey, N. C. (2009). Early life factors in the pathogenesis of osteoporosis. Curr Osteoporos Rep., 7(4), 140–144. doi: 10.1007/s11914-009-0024-1; PMid: 19968918
Zizic T. (2004). Pharmacologic prevention of osteoporotic fractures. Am Fam Physician, 70(7), 1293–3000. PMid: 15508540