Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism

Abstract

Context: An increased risk of fracture in patients with primary hyperparathyroidism (PHPT) compared to the general population has been reported, but available data are controversial.

Objective: The aim of the study was to evaluate the rate of vertebral fractures (VFs) by dual-energy x-ray absorptiometry in postmenopausal women with sporadic PHPT and compare the results with a control group.

Design and setting: A case-control study was performed at a referral center.

Participants: A total of 150 consecutive patients and 300 healthy women matched for age and menopausal age participated in the study.

Results: VFs were detected in 37 of 150 (24.6%) patients and 12 of 300 (4.0%) controls (P < 0.0001). The majority of VFs were mild. Stepwise multiple logistic regression analysis showed that in PHPT patients lumbar spine bone mineral density was the only variable independently associated with the prevalence of VFs (P = 0.003). The rate of fracture was higher in symptomatic (34.1%) than asymptomatic (21.1%) patients, but this difference was not statistically significant (P = 0.15). Among asymptomatic patients, fracture rate was significantly higher in those who met the criteria for parathyroidectomy (28.1%) than in those who did not (11.1%) (P = 0.03). Compared to controls, the fracture rate was significantly higher in patients with symptomatic and asymptomatic PHPT who met the criteria for surgery (P < 0.0001), but not in those who did not meet the criteria (P = 0.06).

Conclusions: VF rate is increased in postmenopausal women with PHPT compared to controls, independently of whether they are classified as symptomatic or asymptomatic. The question of whether the finding of mild morphometric VFs in the latter represents an indication for parathyroid surgery remains to be established.

Figures

Figure 1

Flow diagram of patient recruitment. Symptomatic patients had symptoms of hypercalcemia, nephrolithiasis, osteitis fibrosa cystica, or low-trauma clinical fractures. Criteria for parathyroid surgery were those established by the 2002 Workshop on Asymptomatic PHPT (17).

Figure 2

ROC curve analyses in patients (solid line) and controls (dashed line).

Figure 3

Rate of VF in patients and controls. Left, Symptomatic and asymptomatic patients and controls. Right, Asymptomatic patients, grouped according to whether they met or did not meet the criteria for surgery established by the 2002 Workshop on Asymptomatic PHPT (17), and controls. P value refers to OR between different groups.