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Vitamin D deficiency, osteomalacia, and primary biliary cirrhosis

Response to orally administered vitamin D3

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Abstract

Five patients with primary biliary cirrhosis and vitamin D deficiency (serum 25-hydroxyvitamin D less than 6 ng/ml) are presented. All patients had low serum 24, 25-dihydroxyvitamin D3 concentrations. Three patients had histological osteomalacia, negative calcium balance, and subnormal serum 1,25-dihydroxyvitamin D3. Malabsorption of a standard dose of [3H]vitamin D3 was found in three of four patients with steatorrhea, enabling the effective dose of vitamin D3 given to be calculated. Oral vitamin D3 400–4000 IU/day (effectively 400–1860 IU/day) resulted in a return to normal of the serum vitamin D metabolites, correction of the impaired intestinal calcium absorption and healing of the osteomalacia. Increases in serum calcium, phosphate, and the renal tubular reabsorption of phosphate occurred with a concomitant decrease in serum parathyroid hormone. It is suggested that osteomalacia in primary biliary cirrhosis is the end result of vitamin D deficiency; the hepatic and renal hydroxylations of vitamin D are normal and target tissues are responsive to endogenously produced metabolites of vitamin D.

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References

  1. Atkinson M, Nordin BEC, Sherlock S: Malabsorption and bone disease in prolonged obstructive jaundice. Q J Med 25:299–312, 1956

    Google Scholar 

  2. Kehayoglou AK, Holdsworth CD, Agnew JE, Whelton MJ, Sherlock S: Bone disease and calcium absorption in primary biliary cirrhosis. Lancet 1:715–719, 1968

    Google Scholar 

  3. Ajdukiewicz AB, Agnew JE, Byers PD, Wills MR, Sherlock S: Relief of bone pain in primary biliary cirrhosis with calcium infusions. Gut 15:788–793, 1974

    Google Scholar 

  4. Long RG, Meinhard E, Skinner RK, Varghese Z, Wills MR, Sherlock S: Clinical biochemical and histological studies of osteomalacia, osteoporosis and parathyroid function in chronic liver disease. Gut 19:85–90, 1978

    Google Scholar 

  5. Compston JE, Horton LWL, Thompson RPH: Treatment of osteomalacia associated with primary biliary cirrhosis with parenteral vitamin D2 or oral 25 hydroxyvitamin D3. Gut 20:133–136, 1979

    Google Scholar 

  6. Reed JS, Meredith SC, Nemchausky BA, Rosenberg IH, Boyer JL: Bone disease in primary biliary cirrhosis: Reversal of osteomalacia with oral 25 hydroxyvitamin D. Gastroenterology 78:512–517, 1980.

    Google Scholar 

  7. Long RG, Varghese Z, Meinhard EA, Skinner RK, Wills MR, Sherlock S: Parenteral 1,25 dihydroxycholecalciferol in hepatic osteomalacia. Br Med J 1:75–77, 1978

    Google Scholar 

  8. Compston JE, Crowe JP, Horton LWL: Treatment of osteomalacia associated with primary biliary cirrhosis with oral 1 alpha hydroxyvitamin D3. Br Med J 2:309, 1978

    Google Scholar 

  9. Ponchon G, Deluca HF: The role of the liver in the metabolism of vitamin D. J Clin Invest 48:1273–1279, 1969

    Google Scholar 

  10. Wagonfeld JB, Nemchausky BA, Bolt M, Vander Horst J, Boyer JL, Rosenberg IH: Comparison of vitamin D and 25 hydroxyvitamin in the therapy of primary biliary cirrhosis. Lancet 2:391–394, 1976

    Google Scholar 

  11. Skinner RK, Long RG, Sherlock S, Wills MR: 25 Hydroxylation of vitamin D in primary biliary cirrhosis. Lancet 1:720–721, 1977

    Google Scholar 

  12. Krawitt EL, Grundman ML, Mawer EB: Absorption hydroxylation and excretion of vitamin D3 in primary biliary cirrhosis. Lancet 2:1246–1249, 1977

    Google Scholar 

  13. Ludwig J, Dickson ER, McDonald GSA: Staging of chronic non-supparative destructive cholangitis (syndrome of primary biliary cirrhosis).Virchow's Arch A 379:103–112, 1978

    Google Scholar 

  14. Thompson WG, Thompson GR: Effect of cholestyramine on the absorption of vitamin D3 and calcium. Gut 10:717–722, 1969

    Google Scholar 

  15. Davies M, Mawer EB, Adams PH: Vitamin D metabolism and response to 1,25 dihydroxycholecalciferol in osteoporosis. J Clin Endocrinol Metab 45:199–208, 1977

    Google Scholar 

  16. Taylor CM, Mawer EB, Wallace JE, Cochran M, Russell RGG, Kanis JA: The absence of 24,25-dihydroxycholecalciferol in anephric patients. Clin Sci Mol Med 55:541–547, 1978

    Google Scholar 

  17. Clemens TL, Hendy GN, Papapoulos SE, Fraher LJ, Care AD, O'Riordan JLH: Measurement of 1,25 dihydroxycholecalciferol in man by radioimmunoassay. Clin Endocrinol 11:225–234, 1979

    Google Scholar 

  18. Mawer EB, Backhouse J, Hill LF, Lumb GA, de Silva P, Taylor CM, Stanbury SW: Vitamin D metabolism and parathyroid function in man. Clin Sci Mol Med 48:349–365, 1975

    Google Scholar 

  19. Walton RJ, Bijvoet OLM: Nomogram for derivation of renal threshold phosphate concentration. Lancet 2:309–310, 1975

    Google Scholar 

  20. Davies M, Mawer EB, Krawitt EL: Comparative absorption of vitamin D3 and 25 hydroxyvitamin D3 in intestinal disease. Gut 21:287–292, 1980

    Google Scholar 

  21. Recommended daily amount of food, energy and nutrients for groups of people in the United Kingdom, DHSS. Report on Health and Social Subjects 15. London, HMSO, 1979

  22. Stanbury SW, Taylor CM, Lumb GA, Mawer EB, Berry J, Hann J, Wallace J: Formation of vitamin D metabolites following correction of human vitamin D deficiency. Miner Electrolyte Metab 5:212–227, 1981

    Google Scholar 

  23. Davies M, Mawer EB: The absorption and metabolism of vitamin D3 from parenteral injection sites.In Vitamin D, Basic Research and Its Clinical Application. Proceedings of the Fourth Workshop on Vitamin D. AW Norman, K Shaffer, DV Herrath (eds). Berlin, Walter de Gruyter, 1979, pp 609–612

    Google Scholar 

  24. Long RG, Skinner RK, Wills MR, Sherlock S: Formation of vitamin D metabolites from3H and14C radiolabelled vitamin D3 in chronic liver disease. Clin Chim Acta 85:311–317, 1978

    Google Scholar 

  25. Mawer EB: The role of the liver in the control of vitamin D metabolism.In Vitamin D, Basic Research and Its Clinical Application. Proceedings of the Fourth Workshop on Vitamin D. AW Norman, K Schaffer, DV Herrath (eds). Berlin, Walter de Gruyter, 1979, pp 553–561

    Google Scholar 

  26. Papapoulos SE, Clemens TL, Fraher LJ, Gleed J, O'Riordan JLH: Metabolites of vitamin D in human vitamin D deficiency. Effect of vitamin D3 or 1,25 dihydroxycholecalciferol. Lancet 2:612–615, 1980

    Google Scholar 

  27. Kaplan MM, Goldberg MJ, Matloff DS, Neer RM, Goodman DBP: Effect of 25-hydroxyvitamin D3 on vitamin D metabolites in primary biliary cirrhosis. Gastroenterology 81:681–685, 1981

    Google Scholar 

  28. Compston JE, Crowe JP, Wells IP, Horton LWL, Hirst D, Merrett AL, Woodhead JS, Williams R: Vitamin D prophylaxis and osteomalacia in chronic cholestatic liver disease. Dig Dis Sci 25:28–32, 1980

    Google Scholar 

  29. Stanbury SW, Mawer EB, Lumb GA, Hill LF, Holman CA, Jones M, van den Berg CJ: Some aspects of vitamin D metabolism in man.In Endocrinology 1971. S Taylor (ed). London, William Heineman, 1971, pp 487–499

    Google Scholar 

  30. Clemens TL, Adams JS, Henderson SL, Holick MF: Increased skin pigment reduces the capacity of skin to synthesize vitamin D3. Lancet 1:74–76, 1982

    Google Scholar 

  31. Nagubandi S, Kumar R, Londowski JM, Corradino RA, Tietz PS: Role of vitamin D glucosiduronate in calcium homeostasis. J Clin Invest 66:1274–1280, 1980

    Google Scholar 

  32. Arnaud SB, Goldsmith RS, Lambert PW, Go VLW: 25 Hydroxyvitamin D3: Evidence of an enterohepatic circulation in man. Proc Soc Exp Biol Med 149:570–572, 1975

    Google Scholar 

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Authors and Affiliations

  1. Departments of Medicine and Gastroenterology, University of Manchester and Royal Infirmary, Oxford Road, M13 9Wl, Manchester, England

    M. Davies MRCP, E. B. Mawer PhD, H. J. Klass MRCP, G. A. Lumb PhD, J. L. Berry PhD & T. W. Warnes FRCP

Authors
  1. M. Davies MRCP
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  2. E. B. Mawer PhD
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  3. H. J. Klass MRCP
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  4. G. A. Lumb PhD
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  5. J. L. Berry PhD
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  6. T. W. Warnes FRCP
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Supported by a grant from the British Medical Research Council to Professor S. W. Stanbury.

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Davies, M., Mawer, E.B., Klass, H.J. et al. Vitamin D deficiency, osteomalacia, and primary biliary cirrhosis. Digest Dis Sci 28, 145–153 (1983). https://doi.org/10.1007/BF01315144

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  • DOI: https://doi.org/10.1007/BF01315144

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