Multifactorial risk profile for bone fractures in primary hyperparathyroidism

Area of Science:

• Endocrinology
• Bone Metabolism
• Surgical Patient Evaluation

Background:

• Primary hyperparathyroidism (pHPT) is linked to elevated fracture risk and reduced bone density, often necessitating surgical intervention.
• However, osteoporosis and fracture risk in pHPT patients are frequently multifactorial.
• Identifying specific fracture risk factors within the pHPT population is crucial for optimizing patient management.

Purpose of the Study:

• To investigate variables associated with bone fracture risk in patients undergoing surgery for primary hyperparathyroidism.
• To identify independent predictors of fracture history in the pre-operative pHPT cohort.

Main Methods:

• A cohort of 203 consecutive patients operated for pHPT was analyzed.
• Bone mineral content, biochemical markers, and clinical risk factors for fractures were assessed.
• Fracture history was evaluated for periods up to 5 and 10 years prior to surgery.

Main Results:

• Univariate analysis identified corticosteroid use, alkaline phosphatase, 25-hydroxyvitamin D3, type I collagen telopeptide, bone mineral content, age, menopausal status, and cardiovascular disease history as associated with fractures.
• Multivariate analysis revealed that serum parathyroid hormone (PTH) levels were independently associated with fractures within 5 years prior to surgery.
• Serum 25-hydroxyvitamin D3 levels were independently associated with fractures up to 10 years prior to surgery.

Conclusions:

• Serum levels of 25-hydroxyvitamin D3 and PTH are independently associated with a history of bone fractures in primary hyperparathyroidism.
• These biochemical markers should be considered when assessing fracture risk and evaluating patients for parathyroid surgery.