Risk factors for vertebral fracture in primary hyperparathyroidism.

Area of Science:

• Endocrinology
• Bone Metabolism
• Osteoporosis Research

Background:

• Primary hyperparathyroidism (PHPT) is associated with an increased risk of vertebral fractures (VF).
• Current guidelines recommend VF screening in PHPT, but identifying high-risk patients remains challenging.
• Limited data exist on specific risk factors for VF in the PHPT population.

Purpose of the Study:

• To evaluate clinical and skeletal risk factors associated with vertebral fractures (VF) in patients with primary hyperparathyroidism (PHPT).
• To determine if specific risk factors can accurately identify PHPT patients at greatest risk for VF.

Main Methods:

• Retrospective cross-sectional analysis of 117 PHPT participants.
• Vertebral fracture assessment (VFA) used to identify Grades 2 and 3 VF.
• Association of VF with trabecular bone score (TBS), skeletal parameters, and clinical risk factors analyzed.

Main Results:

• The overall VF rate was 12.8%.
• Older age, worse renal function, prior fracture history, and hip osteoporosis were associated with VF.
• Serum PTH, calcium, TBS, and T-scores at other sites were not significantly associated with VF.
• Identified risk factors demonstrated low sensitivity and limited accuracy in predicting VF.

Conclusions:

• Older age, prior fracture, worse renal function, and hip osteoporosis are risk factors for VF in PHPT.
• These risk factors have low sensitivity, indicating they are insufficient for targeted VF screening in PHPT.
• The findings do not support limiting VF screening to PHPT patients with these specific risk factors, suggesting a need for broader screening strategies.