Parathyroid Hormone Disturbances in Postmenopausal Women with Distal Forearm Fracture

Axel Wihlborg, Karin Bergström, Paul Gerdhem, Ingrid Bergström, Axel Wihlborg, Karin Bergström, Paul Gerdhem, Ingrid Bergström

Abstract

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder with a wide range of adverse effects, such as osteoporosis. Many women are not diagnosed due to asymptomatic disease or vague symptoms but are still at risk of severe adverse effects. Early identification of patients with PHPT is therefore of importance. The aim of this study was to determine PHPT prevalence among postmenopausal women with a distal forearm fracture.

Methods: Recruitment was conducted in conjunction with the occurrence of a distal forearm fracture at Karolinska University Hospital. In total, 161 postmenopausal women were included in a cross-sectional study with repeated evaluations. Analyzes of serum calcium, ionized calcium, phosphate, parathyroid hormone (PTH), and vitamin D were performed. Diagnosis of PHPT was based on clinical evaluations and biochemical definitions of serum calcium and PTH in coherence with previous population prevalence reports.

Results: Mean age was 64.7 (9.5) years, serum calcium 2.33 (0.10) mmol/L, ionized calcium 1.25 (0.05) mmol/L and PTH 54 (26) ng/L. PTH was elevated in 32 (20%) women. In total, 11 (6.8%) women were diagnosed with PHPT; 6 with classical PHPT and 5 with mild PHPT. The prevalence of PHPT was significantly increased compared to the population prevalence of 3.4% (p = 0.022).

Conclusion: Screening postmenopausal women in conjunction with low-energy distal forearm fracture revealed a large number of women with parathyroid disturbance. Evaluation of parathyroid hormone and calcium status in this group of patients seems beneficial.

Conflict of interest statement

The authors declare that they do not have any conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the screening and follow-up procedure. The 2nd blood sample included a full clinical evaluation. A total of 11 women were diagnosed with PHPT after the 2nd and 3rd samples. PHPT = Primary hyperparathyroidism. a Declined or no follow-up available. b No further follow-up indicated. c Already diagnosed with PHPT at the time of fracture
Fig. 2
Fig. 2
Distribution at screening of the 161 women with a distal forearm fracture. a Serum calcium corrected for serum albumin (mmol/L). b Ionized calcium (mmol/L)
Fig. 3
Fig. 3
Serum calcium corrected for serum albumin (mmol/L) and PTH (ng/L) at screening of the 11 women diagnosed with PHPT during follow-up. Arranged according to the biochemical definition of PHPT at screening. No criteria = did not meet any of the biochemical definitions of serum calcium and PTH at screening

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