# Dramatic Deterioration of Subclinical Hyperparathyroidism in Children and Adolescents During the Post-COVID-19 Period

## TL;DR

The study shows a significant rise in vitamin D deficiency and subclinical hyperparathyroidism in children post-COVID-19, linked to potential health risks.

## Contribution

The study reveals a marked deterioration in vitamin D status and calcium metabolism in children during the post-COVID-19 period.

## Key findings

- 60.8% of children had vitamin D deficiency or insufficiency, worsening with age.
- Subclinical hyperparathyroidism increased to 21.5%, with 73.5% of those being vitamin D deficient or insufficient.
- Vitamin D deficiency was linked to higher BMI and seasonal variations, with levels dropping in winter.

## Abstract

Background: Vitamin D is a steroid hormone, essential for the immune system and bone health. Since the sun is meant to provide at least 80% of daily vitamin D requirements, the COVID-19 pandemic is likely to have induced a considerable influence on calcium metabolism. Methods: We analyzed data from 1138 children, seen in an outpatient pediatric endocrinology clinic from 2022–2023. Vitamin D status was classified as deficiency if 25(OH)D ≤ 20 ng/mL, insufficiency < 30 ng/mL, and sufficiency ≥ 30 ng/mL. Results: Overall, 60.8% of children had vitamin D deficiency or insufficiency worsened with age (p < 0.005), and with adolescent males having higher 25(OH)D concentrations than females (p < 0.05). A negative correlation was found between 25(OH)D and BMI SDS (R2 = 0.02, p < 0.001), and 25(OH)D concentrations varied seasonally, decreasing in winter. Subclinical hyperparathyroidism [parathyroid hormone (PTH) > 45 pg/mL) and normal calcium] was found in 21.5% of children, with 73.5% of them being vitamin D deficient or insufficient. A negative correlation between PTH and 25(OH)D was observed, with PTH plateauing at 25(OH)D above 40 ng/mL (p < 0.001). Conclusions: Compared to the pre-pandemic data (2016–2018), with only 5.1% of children having subclinical hyperparathyroidism (p < 0.001), these findings suggest a marked deterioration in vitamin D status and calcium metabolism in children, with possible unforeseen consequences for bone, immune, and general health.