Future Directions in Hypercalcemic and Normocalcemic Primary Hyperparathyroidism: FRAXplus for 10-Year Fracture Risk...

Area of Science:

• Endocrinology
• Osteoporosis Research
• Medical Diagnostics

Background:

• Primary hyperparathyroidism (HPT) is associated with osteoporosis and fractures in both hypercalcemic (HC-HPT) and normocalcemic (NC-HPT) forms.
• Accurate assessment of osteoporotic fracture risk is essential for managing HPT patients.

Purpose of the Study:

• To compare the 10-year fracture risk assessment using the traditional FRAX tool versus the novel FRAXplus algorithm in menopausal women with HPT.
• To evaluate the impact of HPT-specific adjustments and bone mineral density (BMD) measurements (lumbar vs. femoral neck) on fracture risk prediction.

Main Methods:

• A retrospective, single-center study included 131 menopausal women (51.15% with HPT) and matched controls.
• 10-year major osteoporotic fractures (MOF) and hip fracture (HF) risks were calculated using FRAX and FRAXplus, with and without HPT adjustments and incorporating lumbar or femoral neck BMD.

Main Results:

• FRAXplus with HPT adjustment and lumbar BMD showed significantly higher MOF (4.55% vs. 3.7%) and HF (1.05% vs. 0.5%) risks in HPT patients compared to controls.
• HPT adjustment in FRAXplus consistently yielded higher MOF and HF risks compared to non-adjusted FRAX.
• Parathormone levels correlated positively with HF risk, while P1NP correlated negatively with MOF and HF risks in the HPT group.

Conclusions:

• The traditional FRAX tool may underestimate fracture risk in HPT patients, highlighting the need for novel models like FRAXplus with HPT adjustments.
• FRAXplus demonstrates improved accuracy in predicting osteoporotic fracture risk in HPT, irrespective of hypercalcemic or normocalcemic status.
• Further research is warranted to refine fracture risk assessment tools for diverse HPT patient populations.