Risk of fractures in primary hyperparathyroidism: a systematic review and meta-analysis

Area of Science:

• Endocrinology
• Bone Metabolism
• Epidemiology

Background:

• Primary hyperparathyroidism (PHPT) is linked to an elevated fracture risk, though evidence from smaller studies requires consolidation.
• Previous research indicates potential bone density loss and increased fragility in PHPT patients.

Purpose of the Study:

• To systematically review and meta-analyze the existing literature on fracture risk in individuals with PHPT.
• To quantify the overall and site-specific fracture risk associated with PHPT.

Main Methods:

• A comprehensive literature search was conducted in EMBASE and PubMed.
• 12 relevant studies were included in the meta-analysis, pooling data to calculate odds ratios (OR) and 95% confidence intervals (CI).
• Subgroup analyses were performed for specific fracture sites and patient cohorts (e.g., mild PHPT, postmenopausal women).

Main Results:

• The meta-analysis of 5 studies revealed a significantly increased risk of any fracture in PHPT patients (OR 2.01; 95% CI, 1.61-2.50).
• Increased risk was observed for forearm (OR 2.36; 95% CI, 1.64-3.38) and spine fractures (OR 3.00; 95% CI, 1.41-6.37).
• Hip fracture risk was not significantly elevated (OR 1.27; 95% CI, 0.97-1.66), while vertebral fracture risk was notably higher in analyses restricted to healthy controls, mild PHPT, and postmenopausal women.

Conclusions:

• Primary hyperparathyroidism is associated with a substantially increased risk of fractures.
• The elevated risk extends to various skeletal sites and is evident even in cases of mild PHPT and among postmenopausal women, underscoring the systemic impact of the condition on bone health.