Prevalence of Vertebral Fractures in Primary Hyperparathyroidism

Document Type

Conference Proceeding

Publication Date

2-1-2022

Publication Title

J Bone Miner Res

Abstract

Background: Primary hyperparathyroidism (PHPT) is one of the known causes of secondary osteoporosis. PHPT is associated with increased bone turnover, low bone density and quality; but there have been conflicting results on the risk of fractures in patients with PHPT. Objective: To determine the prevalence of vertebral fractures (VFx) and risk factors associated in patients with PHPT. Design: Retrospective cross-sectional study of patients with PHPT over a two-year period. Setting: Academic primary and tertiary care setting. Main outcome measured: Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) of the lumbar spine (LS), femoral neck (FN) and forearm. Prior images of spine were assessed using the Genant scale by two independent reviewers to identify asymptomatic VFx. Electronic medical records were reviewed to identify previously reported or treated fractures at any site. Results: 184 patients [(146 women and 38 men); 122 Caucasians (66%), 40 African Americans (22%) and 22 of unspecified race (12%)] was included in our study. Mean age was 62.6 +/- 13.2 years and prevalence of fracture at any site was 24% (n=44). The highest prevalence of fractures was vertebral (n=24,16%), followed by other sites (n=14,7%), wrist fractures (n=8,4%) and hip fractures (n=2,1%) respectively. No significant difference was noted in mean +/- SD serum parathyroid hormone (PTH) (147 +/- 73 vs 134 +/- 87 pg/mL, p=0.34), creatinine (0.90 +/- 0.23 vs 0.91 +/- 0.34 mg/dL, p=0.43) and corrected calcium (11.15 +/- 0.62 vs 10.94 +/- 0.76 mg/dL, p=0.11) in PHPT patients with and without VFx. Mean T-score +/- SD and BMD FN +/- SD was significantly lower in patients who had fractures in any site [(T-score: -1.77 +/- 1.22 vs -1.20 +/- 1.04, p=0.02); (BMD: 0.68 +/- 0.13 vs 1.45 +/- 0.73 g/cm3, p=0.04)], but otherwise, no significant difference was noted in BMD and T-score by DXA of the LS and forearm. In a subgroup study of women only (n=146), prevalence of VFx was significantly higher in >=65 years old vs <65 years old [(n=14, 9.5% vs n=6,4.1%), p=0.016]. Multivariate analysis (age, corrected serum calcium, PTH, and LS BMD) to predict risk of VFx in all patients and women only identified age to be the only significant risk factor (p=0.02 and p=0.05, respectively). Conclusion: VFx is more prevalent in comparison to other fracture sites in patients with mild PHPT. Increasing age is the only significant risk factor for VFx in PHPT patients as in the general population.

Volume

37

First Page

80

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