The Potential Role of Preoperative Trabecular Bone Score in Predicting Changes in Bone Mineral Density After Parathyroid
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ORIGINAL SCIENTIFIC REPORT
The Potential Role of Preoperative Trabecular Bone Score in Predicting Changes in Bone Mineral Density After Parathyroidectomy David Tak Wai Lui1 • Matrix Man Him Fung2 • Chi Ho Lee1 • Carol Ho Yi Fong1 • Connie Hong Nin Loong1 • Allan Hoi Kin Lam2 • Kathryn Choon Beng Tan1 • Yu Cho Woo1 Brian Hung Hin Lang2
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Accepted: 15 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The skeletal indication for parathyroidectomy for primary hyperparathyroidism (PHPT) is based on bone mineral density (BMD) T-score \ - 2.5. Whether trabecular bone score (TBS) additionally identifies patients who benefit from parathyroidectomy in terms of bone health is unknown. We aimed to study changes in BMD and TBS among Chinese who underwent curative parathyroidectomy for PHPT, in relation to their preoperative parameters, especially in those with worst site BMD T-score C - 2.5 (non-osteoporotic range). Methods We included consecutive Chinese individuals who underwent curative parathyroidectomy during 2002–2015 for PHPT and completed preoperative and postoperative BMD and TBS measurements in Queen Mary Hospital. Correlations between preoperative parameters and changes in densitometric parameters were studied. Results 45 Chinese individuals (13 men, 32 women) were included (mean age 62.0 ± 10.0 years and BMI 24.6 ± 4.7 kg/m2). After parathyroidectomy, BMD at lumbar spine (LS) improved by 6.7% (p \ 0.001) while TBS did not change. Among women, peak preoperative parathyroid hormone and calcium levels independently predicted LS BMD gain. Among women with BMD in non-osteoporotic range, LS BMD also improved after parathyroidectomy, where preoperative TBS was the only significant variable inversely correlating with percentage change in LS BMD (q - 0.775, p = 0.005). Particularly, those with preoperative TBS B 1.25 gained 7.1% LS BMD postparathyroidectomy (p = 0.003). Conclusions LS BMD, but not TBS, improved after parathyroidectomy. Among non-osteoporotic PHPT women, preoperative TBS inversely correlated with postoperative BMD improvement. Hence, low preoperative TBS may be an additional indication for surgical benefit with parathyroidectomy in non-osteoporotic PHPT women, as those with worse preoperative TBS tend to benefit more from surgery.
Introduction
David Tak Wai Lui and Matrix Man Him Fung are co-first authors. & Brian Hung Hin Lang [email protected] 1
Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
2
Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Primary hyperparathyroidism (PHPT) is typically associated with deterioration in bone mineral density (BMD) at the cortical sites and relatively preserved BMD over predominantly trabecular sites [1], but individuals with PHPT are at increased risks of both non-vertebral and vertebral fractures [2]. BMD underestimates these fracture risks [3], as bone quality is one of the factors not captured by BMD. Indeed, bone microarchitecture is impaired at both tra
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