Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

Area of Science:

• Endocrinology
• Osteoporosis Research
• Bone Metabolism

Background:

• Primary hyperparathyroidism (PHPT) is associated with vertebral fractures (VFx), even with normal bone mineral density (BMD).
• Bone quality, reflecting micro-architecture, may play a crucial role in VFx development in PHPT.
• Trabecular bone score (TBS) is a novel texture analysis tool assessing bone micro-architecture from DXA scans.

Purpose of the Study:

• To evaluate the association between TBS and VFx in PHPT patients.
• To compare the efficacy of TBS versus BMD in detecting VFx.
• To assess changes in TBS and BMD following surgical or conservative treatment for PHPT.

Main Methods:

• A case-control study involving 92 PHPT patients and 98 controls.
• DXA scans were used to measure TBS, lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD.
• Vertebral fractures (VFx) were assessed using spinal radiographs.

Main Results:

• PHPT patients exhibited significantly lower TBS and higher VFx prevalence compared to controls (P<0.0001).
• TBS was independently associated with VFx (OR 1.4, P=0.02) and demonstrated superior VFx detection sensitivity/specificity over LS, TH, and FN BMD.
• Following surgery, TBS, LS-BMD, TH-BMD, and FN-BMD significantly increased (P<0.0001). In conservatively treated patients, TBS decreased in those with incident VFx (P=0.048).

Conclusions:

• Reduced bone quality, indicated by lower TBS, is prevalent in PHPT and linked to VFx.
• TBS is a valuable tool for assessing VFx risk in PHPT, outperforming traditional BMD measurements.
• Surgical intervention for PHPT leads to significant improvements in bone quality (TBS) and BMD.