Clinical Section

Secondary Hyperparathyroidism Is Associated with Increased Risk of Hospitalization or Death in Elderly Adults Living in a Geriatric Institution
Melissa Orlandin Premaor^a, Rosana Scalco^b, Marília Judith Souza da Silva^c, Tania Weber Furlanetto<sup>a

a</sup>Division of Internal Medicine and
^bClinical Pathology Laboratory, Hospital de Clínicas de Porto Alegre, and
^cPadre Cacique Asylum, Porto Alegre, Brazil

Address of Corresponding Author

Gerontology 2009;55:405-410 (DOI: 10.1159/000227760)

  Key Words

• Secondary hyperparathyroidism
• Adults, elderly
• Hospitalization risk
• Mortality risk
• Geriatric institution

  Abstract

Background: The presence of secondary hyperparathyroidism is very frequent in the elderly population living in geriatric institutions. It has been associated with an increased mortality rate in previous studies. Objectives: To evaluate the association of secondary hyperparathyroidism with mortality or hospitalization or both (combined outcome) during a 6-month period in individuals living in geriatric institutions. Methods: A cohort of 100 individuals aged between 65 and 102 years living in geriatric institutions in the city of Porto Alegre, Brazil, was prospectively studied. Serum levels of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), albumin, total calcium, phosphorus, magnesium, creatinine and alkaline phosphatase were measured. The glomerular filtration rate (GFR) was calculated using the Cockcroft-Gault equation. Secondary hyperparathyroidism was defined as serum PTH levels higher than 48 pg/ml and normal or reduced serum calcium levels. The deaths were verified by means of death certificates and hospitalization by the discharge summaries provided by the Brazilian health system hospitals. Results: Fifty-eight percent of the individuals had secondary hyperparathyroidism, defined as serum PTH >48 pg/ml and normal or low serum calcium. Mean serum 25(OH)D levels were 12.5 ± 8 ng/ml. The odds ratio of an individual with secondary hyperparathyroidism to die, to be hospitalized or to have the combined outcome within 6 months was 6.6 [confidence interval (CI) 95% 0.8–54.6; p = 0.07], 10.7 (CI 95% 1.3–85.9; p = 0.007) and 5.20 (CI 95% 1.10–27.7; p = 0.04), respectively. Secondary hyperparathyroidism and body mass index were independently associated with the combined outcome, after correction for the GFR and 25(OH)D. Conclusion: Secondary hyperparathyroidism could be an important prognostic factor for individuals living in geriatric institutions.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Melissa Orlandin Premaor, MD, PhD
Division of Internal Medicine, Hospital de Clínicas de Porto Alegre
Rua Ramiro Barcellos 2350/700
Porto Alegre, RS (Brazil)
Tel./Fax +55 51 2101 8157, E-Mail mopremaor@bol.com.br

  Article Information

Received: February 26, 2008
Accepted: June 26, 2008
Published online: July 2, 2009
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 3, Number of References : 34