Calcium and Bone Metabolism / Hyperparathyroidism

Lately this seems to be a topic of conversation.  Please before you let a doctor start telling you to take less calcium or vitamin D, or worse, remove all or part of your parathyroid please have an understanding of the following:

Basic explanation of bone metabolism (especially important for us malabsorbers with reduced stomach acid).  PTH (parathyroid hormone), Calcium, and vitamin D3 have a very strong inter-relationship.  It is critical for the our bodies to maintain a certain amount of calcium in our blood to support life functions.  PTH and D3 work on a feedback / antagonist system to keep your blood serum calcium levels stable.  If you do not have enough calcium available, your Parathyroid secretes ever increasing amounts of PTH to signal bones to release calcium (turning your bones into a sponge / osteoporosis)  so it's available to maintain blood serum levels.  It also suppresses D3 production.

Conversely, if your body has an ample supply of calcium, D3 suppresses your Parathyroid and helps push the extra calcium into bone production (strong healthy bones). 

If we are not getting enough calcium and D3, our PTH lab values will increase, our D3 levels will decrease, and until we are seriously deficient- our calcium labs will stay the same.  I can tell you that my former PCP or current Internest don't get this, so you can not rely on them for an accurate diagnosis.

What do your calcium and vitamin D, along with your PTH labs look like?  Are you supplementing adequately with Calcium Citrate and Vitamin D3?  You and your endocrinologist need to really evaluate these questions first. 

FWIW:  I have no medical background.  I am just a nobody with an interest in biology.

Hi Ann,

I'm sitting here thinking how ironic, since I'm involved in the throws of this issue (sort of) right now...

Had my 6 yr labs in May...My D3 & Calcium both well within the normal ranges but my PTH has bottomed out @ 7(so far under the range it made me gasp) from just a year ago when it was 24 (acceptable if a little low)...My doc thinks one or two of my supplements may be leading to a false higher reading of calcuim and had me discontinue them for now...I just went for a re-test yesterday to see what comes up now - appt with the doc is next week...I'm on pins & needles to see how it turns out...To add a little twist, my regular PCM authorized a bone density scan for me earlier this year because of my personal concerns in this area & it came back completely normal...

, So basically I'm sitting here thinking, what the heck??

I've read that phospherous can bring it down, but really with your D3 and calcium well within range, I think you're bones are in a great place.

I just had my lab work done last month and mine came back with my PTH at 6- but my PCP didn't seem concerned about it even though it said that was low....  my calcium PTH is 9.6  and my vitamin D25 is 31..... I have started taking the dry D3 50,000 IU daily 5x's a week.... any thoughts/suggestions?  thanks!!

I think that looks like a very reasonable plan.  I would just be sure to keep an eye on that calcium lab and be sure it doesn't drop.

Hi ann:  Thank you for your explanation(s) and also for cautioning  those of us who are RNY WLS patients (and perhaps others also-- but in particular RNYers) about the importance of being your own advocate when it comes to these important vitamins/minerals.
Most of your personal MD's (mine included) while they certainly know all the benefits of us having WLS and most are big proponents of it, they do not have a whole lot of experience with the after effects of these surgeries!! How about blood tests at least twice a year? and if low or high levels of something comes  up ( i.e. Vit D3 or Calcium)  then treat it appropriately:
 My doctor prescribed 50,000 i.u.'s of VIt D2(gel form) Now I have told him it doesn't work for me due to malabsorption, etc. and he said  take it anyway! duh! why??? My levels were still low after taking the prescription he gave me.  I took my own supplements of dry D3 but they were not a high enough dosage.  I highly recommend vitalady here on this forum .  I am not advertising for her or anything, just suggesting as her site  has alot of infor for RNY'ers and what supplements may/may not work for you and also higher dosages.
Thank you again Ann for posting this.  I feel (IMO) this is an area sorely lacking in the post op WLS care that needs to be addressed more often. 
I don't want to find out 6 years out that I have developed severe osteoporosis that had I known about supplements and the proper dosages to take, might have prevented this disease process.
 Sorry I ramble I just feel very strongly that this area is sorely lacking in most post-op WLS care, with in particular,  our personal care physicians.  I am not saying they aren't intelligent/ knowledgeable  just most don't know as much about the post op care as they should.
Take care and thank you again for your post.

Thanks. 

I absolutely adore Vitalady and all she does for our WLS community.  She is more than happy to provide free consultation and advice with no expectation of your business.  Her vitamins are very competatively priced and formulated to fit our needs.  Customer service is superb.  I truly believe that she and her husband truly care for our well-being way beyond being paying customers!

My understanding of low PTH lab numbers accompanied by normal D and Calcium lab values is it's no cause for concern.  Keep your supplementation going.  Keep an eye on your calcium labs.  There isn't a negative impact on haveing a low PTH number.

If your calcium lab drops below range, that is a problem.  You are experiencing HypOparathyroidism that  leads to Hypocalcemia.  There is a huge impact on your body.  I really like this website for a better explanation.

http://parathyroid.com/hypoparathyroidism.htm