Multifactorial risk profile for bone fractures in primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (pHPT) is associated with an increased fracture risk, and decreased bone density thus has been considered an indication for surgery. However, many pHPT patients have a multifactorial risk profile for osteoporosis and bone fractures. The aim of the present study was to evaluate variables associated with fracture risk within the group of pHPT patients. A series of 203 consecutive patients operated for pHPT were investigated with bone mineral content and biochemical and clinical risk factors for bone fracture. Seventeen patients (8%) had a history of at least one bone fracture up to 5 years before pHPT surgery. Twenty-six patients (13%) had a history of at least one fracture during the 10-year period prior to surgery. In the univariate analyses corticosteroid treatment, serum levels of alkaline phosphatase, 25-hydroxyvitamin D3, type I collagen telopeptide, and bone mineral content were found to be associated with a history of bone fractures up to 10 years before surgery. Additionally, age and menopausal status were of importance for fractures during the 10-year-period, whereas a history of cardiovascular disease was important for fractures during the 5-year-period prior to surgery. Multivariate analyses showed that serum level of PTH was independently associated with bone fractures during the 5-year period prior to pHPT surgery and further that serum level of 25-hydroxyvitamin D3 was associated with fractures up to 10 years before surgery. In conclusion, serum levels of 25-hydroxyvitamin D3 and PTH were independently associated with a history of bone fractures in pHPT. These variables should be considered when evaluating patients for parathyroid surgery.

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

“…Some authors suggest that BMD is increased with repletion in both sites whereas others claim that 25 OHD has no independent effect on BMD (22,23). Besides the negative effects on BMD, low vitamin D levels may contribute to profound and lengthened hypocalcaemia (hungry bone syndrome) after parathyroidectomy (20). Therefore it has generally been recommended to supplement vitamin D to normalize 25(OH) vitamin D levels, although there are so far no available data to support the premise that this would contribute to the prevention of hypocalcaemia.…”

“…Epidemiological studies suggests that the prevalence of hypovitaminosis D (including deficiency and insufficiency) is more prevalent in patients with PHPT than in the general population regardless of sex, age and the season (18). The reason for that co- (20). In addition to that there is an increased risk of osteoporotic fractures in patients with PHPT in case of low vitamin D levels (21).…”

Biochemical effects of calcifediol supplementation in mild, asymptomatic, hyperparathyroidism with concomitant vitamin D deficiency

“…The pathophysiological mechanisms responsible for the low serum 25(OH)D level in PHPT are not completely clarified. The data obtained from several studies suggest that vitamin D status might influence the clinical and biological expression of PHTP [1,2,[4][5][6][7][8][9][10][11][12][13][14][15] and even recovery after surgical treatment [11,16,17], although some authors have not found such an association [18,19].…”

Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

“…In the present study of vitamin D therapy in patients with PHPT, vitamin D insufficiency is defined by a serum level of 21-29 ng/ml (52.5-72.5 nmol/l) and vitamin D deficiency by a serum 25-OHD level of %20 ng/ml (%50 nmol/l). In patients with PHPT, subnormal serum 25-OHD levels have been associated with larger parathyroid glands and parathyroid tumours, higher serum parathyroid hormone (PTH), calcium and alkaline phosphatase levels, accelerated bone turnover and a greater likelihood of abnormal bone and fractures (3,4,12,13). Whereas vitamin D repletion is routinely recommended for patients with hypovitaminosis D, there has been reluctance to restore serum 25-OHD levels to normal in PHPT due to concerns of potentially greater hypercalcaemia and hypercalciuria (3,14).…”