Safety and efficacy of common vitamin D supplementation in primary hyperparathyroidism and coexistent vitamin D deficiency and insufficiency: a systematic review and meta-analysis.

Abstract

Primary hyperparathyroidism (PHPT) is characterized by excessive secretion of parathyroid hormone (PTH). Vitamin D deficiency can stimulate parathyroid secretion. However, whether to correct vitamin D deficiency in patients with PHPT is controversial. We aimed to evaluate the safety and efficacy of vitamin D replacement in patients with PHPT. We searched PubMed, Cochrane Library, and Embase. The relevant data were extracted from the included documents. The methodological items for non-randomized studies score entries were used for evaluation of quality. Review Manager 5.3 and Stata 12.0 were used for statistical analysis. A total of 11 articles were included with a total of 388 patients. The serum calcium mean difference (MD) was -0.06mg/dL [95% confidence interval (95% CI) -0.16, 0.04]. Subgroup analysis showed that serum calcium levels did not change if the intervention time exceeded 1month. The 24-h urinary calcium MD was 36.78mg/day (95% CI -37.15, 110.71), which indicated that there was no significant effect of vitamin D supplementation on 24-h urinary calcium levels. The MD of PTH was -16.01pg/mL (95% CI -28.79, -3.24). Subgroup analysis according to the intervention time showed that vitamin D intervention for more than 1month significantly reduced PTH levels. The ALP MD was -10.81 U/L (95% CI -13.98, -7.63), which indicated Vitamin D supplementation reduced its level. The MD of 25-hydroxyvitamin D was 22.09μg/L (95% CI 15.01, 29.17), and no source of heterogeneity was found. Vitamin D supplementation in patients with PHPT and vitamin D deficiency significantly reduces PTH and ALP levels without causing hypercalcemia and hypercalciuria.