Risk factors for vertebral fracture in primary hyperparathyroidism
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ORIGINAL ARTICLE
Risk factors for vertebral fracture in primary hyperparathyroidism Minghao Liu1 John Williams1 Jennifer Kuo2 James A. Lee2 Shonni J. Silverberg1 Msarcella D. Walker ●
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Received: 5 June 2019 / Accepted: 23 September 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose Screening for vertebral fractures (VF) in primary hyperparathyroidism (PHPT) is recommended, but there are limited data regarding which patients are at greatest risk for VF. We evaluated risk factors for VF in PHPT. Methods This is a retrospective cross-sectional analysis of 117 participants with PHPT. We assessed Grades 2 and 3 VF by vertebral fracture assessment (VFA) and the association of VF with the trabecular bone score (TBS), other skeletal parameters and clinical risk factors. VFA was performed only in those who met National Osteoporosis Foundation criteria for VFA screening. Results T-scores were in the osteopenic range and TBS was degraded. Overall VF rate based on VFA or other imaging was 12.8%. Serum PTH, calcium and TBS were not associated with VF. Those with VF were older (p = 0.04), had worse renal function (p = 0.04), were more likely to have received osteoporosis treatment (p = 0.03), and tended to have had a prior fracture (p = 0.06). T-scores did not differ by fracture status at any skeletal site. Those with VF had nine times the odds of osteoporosis at the hip (95% CI 2.4–34.5), but this risk factor had low sensitivity (46.7%) for VF. Hip T-score < −2.6, Age > 78.6 years, and GFR < 58.8 ml/min/1.73 m2 (thresholds maximizing sensitivity and specificity) had areas under the curve of 0.60–0.67 for VF (all p < 0.05) and low sensitivity. Findings were similar when analyses were limited to women. Conclusions In PHPT, VF risk factors included older age, prior fracture, worse renal function and osteoporosis at the hip, but not osteoporosis at other sites, TBS or biochemical indices of PHPT. Since identified risk factors had low sensitivity and were generally inaccurate for categorizing those with VF, the data do not support limiting screening to PHPT patients with these specific VF risk factors. Keywords Primary hyperparathyroidism Vertebral fractures TBS Prevalence ●
Introduction Primary hyperparathyroidism (PHPT) is a common condition characterized by hypercalcemia and elevated or inappropriately normal parathyroid hormone (PTH). Today, PHPT is usually asymptomatic and detected incidentally in countries where calcium is routinely measured [1]. Despite being asymptomatic, PHPT often causes bone loss that can be detected by dual energy X-ray absorptiometry (DXA). In PHPT, while mean T-scores as measured by DXA are
* Msarcella D. Walker [email protected] 1
Division of Endocrinology, Department of Medicine, Columbia University, 180 Fort Washington Avenue, New York, NY 10032, USA
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Department of Surgery, Columbia University, 180 Fort Washington Avenue, New York, NY 10032, USA
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typically in the osteopenic range, there is a prefer
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