Fracture risk in hypoparathyroidism: a systematic review and meta-analysis

Area of Science:

• Endocrinology
• Bone Metabolism
• Clinical Epidemiology

Background:

• Hypoparathyroidism (hypoPT) is associated with higher bone mineral density, theoretically suggesting a reduced fracture risk.
• However, existing clinical evidence on fracture risk in hypoPT patients is conflicting.
• This study addresses the need for a clear summary of fracture risk in this population.

Purpose of the Study:

• To systematically review and meta-analyze observational studies to precisely determine fracture risk in patients with hypoparathyroidism (hypoPT).
• To investigate fracture risk specifically in nonsurgical and postsurgical hypoPT subgroups.
• To provide evidence-based recommendations for managing fracture risk in hypoPT.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, and Web of Science databases up to March 8, 2021.
• Seven high-quality observational studies involving 1470 patients with hypoPT were included.
• Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated, with subgroup analyses for nonsurgical and postsurgical hypoPT.

Main Results:

• Hypoparathyroidism (hypoPT) patients exhibited a significantly increased risk of vertebral fractures (OR 2.22, 95% CI: 1.23, 4.03).
• This elevated risk was specifically observed in patients with nonsurgical hypoPT (OR 2.31, 95% CI: 1.32, 4.03).
• No increased or decreased risk of humerus, proximal femur/hip, or any fractures was found in hypoPT patients compared to controls.

Conclusions:

• Nonsurgical hypoparathyroidism (hypoPT) is associated with a nearly 2-fold increased risk of vertebral fractures.
• Patients with nonsurgical hypoPT require active screening for vertebral fractures, independent of their bone mineral density (BMD).
• Further research may explore the mechanisms underlying this specific fracture risk in nonsurgical hypoPT.