Estimated fracture risk in osteopenic patients with primary hyperparathyroidism

While osteoporosis in primary hyperparathyroidism (PHPT) is widely studied, PHPT patients with osteopenia remain less characterized. This study aimed to evaluate the prevalence, biochemical features, and estimated fracture risk of osteopenic PHPT patients in a real-life cohort.

We retrospectively analyzed a consecutive series of PHPT patients with available densitometric data at three sites. Postmenopausal women and men over 50 years old with PHPT and osteopenia were selected. FRAX scores were used to estimate fracture risk, and subgroup analyses were conducted based on sex, age, and PHPT clinical presentation.

One hundred out of 439 PHPT patients (22.8%) were osteopenic. As compared to osteopenic women, osteopenic men were older (p = 0.03), had higher BMD at the spine and femoral neck (p = 0.007 and p = 0.006, respectively), and more frequent occurrence of nephrolithiasis (p = 0.046). Osteopenic patients older than 65 years had worst FRAX scores and higher prevalence of comorbidities, as type 2 diabetes and hypertension, than their younger counterparts (both p < 0.001). FRAX scores of osteopenic PHPT patients were not different according to their clinical classification of PHPT.

Patients with osteopenia account for about one fifth of our whole series and two thirds of them met surgical indication according to latest international guidelines. Neither densitometric data nor estimated fracture risk differed between osteopenic PHPT patients meeting or not surgical criteria.