Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

Objective Primary hyperparathyroidism (PHPT) is one of the most frequently diagnosed endocrine disorders, but few studies have focused on hospital management of the disease in Europe. We investigated the frequency of hospital admission for diagnosis and surgical treatment of PHPT in Italy. Design A retrospective study was conducted for investigating the hospital care for PHPT in Italy. Methods We retrieved data from the ‘Record of Hospital Discharge’ of the Italian Health Ministry, from 2006 to 2011, and analyzed the codes corresponding to PHPT-related diagnoses and surgical procedures. Results Overall, 46 275 hospitalization episodes for PHPT were identified during the entire period (69% in women and 31% in men; mean age 63.3±39.8 years). Patients’ mean age significantly increased during the years (P<0.001). The mean length of stay was 8.2±10.5 days (28% of the episodes requiring <3 days of stay). Admissions for surgical procedures were 12 457 accounting for 26.9% of the total hospitalizations. There was a trend to a significant increase in the percentage of surgery (P<0.05). The mean hospitalization rate for PHPT was 12.9/100 000 inhabitants per year and the trend showed a significant decrease during the period of 2006–2011 (P<0.0001). The mean hospitalization rate for PHPT surgery was 3.65/100 000 per year, which significantly increased over time (P<0.001). Conclusions PHPT considerably influences the Italian Hospital healthcare system. We observed a tendency to a decrease in the frequency of hospitalization during the period of 2006–2011, most probably because of economic issues, a concomitant increased age of patients, and, interestingly, also a progressive increase in the percentage of surgical treatment among patients admitted for PHPT.

Section: Introductionsupporting

confidence: 88%

Hospital care for primary hyperparathyroidism in Italy: a 6-year register-based study

Cipriani

Carnevale

Biamonte

et al. 2014

“…In keeping with this notion, data from another cohort of PHPT patient revealed an increased fracture risk as early as 10 years before the diagnosis of PHPT had been made (6). This may be due to the fact that the diagnosis of secondary osteoporosis can be challenging and, in particular, the diagnosis of PHPT may be concealed by other factors, such as concomitant hypovitaminosis D (31). The patients included in this study had been referred to our tertiary care centers by general practitioners, and the diagnosis of PHPT may depend on the individual clinical picture.…”

Section: Fractures In Primary Hyperparathyroidismmentioning

confidence: 89%

Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism

Eller-Vainicher

Battista

Guarnieri

et al. 2014

Self Cite

Objective: To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT). Design and methods: A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing. Results: Fractured patients (nZ100, 37.6%) had lower sCa (10.8G0.7 mg/dl) and Z-LS BMD (K1.0G1.44), higher age (61G10 years), and prevalence (51%) of R1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (nZ166, 11.2G1.0 mg/dl, K0.57G0.97, 58G13 years, and 38% AS/SS, respectively, P!0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, PZ0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, PZ0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, PZ0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, PZ0.05). The presence of two out of three factors (age R58 years, sCa !10.8 and Z-LS BMD%K1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P!0.0001). Conclusions: In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP.

“…In addition, given the recent evidences showing that SH is definitely more frequent than clinically overt cortisol excess and that SH is associated with an increased risk of osteoporosis and fragility fractures, several studies have been designed for assessing the prevalence of an otherwise asymptomatic SH in patients with osteoporosis (30,116,117,118,119). Table 2 summarizes the studies specifically designed for assessing the prevalence of SH among patients with apparent primary osteoporosis.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Endogenous subclinical hypercortisolism and bone: a clinical review

Chiodini

Vainicher

Morelli

et al. 2016

In recent years, the condition of subclinical hypercortisolism (SH) has become a topic of growing interest. This is due to the fact that SH prevalence is not negligible (0.8-2% in the general population) and that, although asymptomatic, this subtle cortisol excess is not harmless, being associated with an increased risk of complications, in particular of osteoporosis and fragility fractures. As specific symptoms of hypercortisolism are absent in SH, the SH diagnosis relies only on biochemical tests and it is a challenge for physicians. As a consequence, even the indications for the evaluation of bone involvement in SH patients are debatable and guidelines are not available. Finally, the relative importance of bone density, bone quality and glucocorticoid sensitivity in SH is a recent field of research. On the other hand, SH prevalence seems to be increased in osteoporotic patients, in whom a vertebral fracture may be the presenting symptom of an otherwise asymptomatic cortisol excess. Therefore, the issue of who and how to screen for SH among the osteoporotic patients is widely debated. The present review will summarize the available data regarding the bone turnover, bone mineral density, bone quality and risk of fracture in patients with endogenous SH. In addition, the role of the individual glucocorticoid sensitivity in SH-related bone damage and the problem of diagnosing and managing the bone consequences of SH will be reviewed. Finally, the issue of suspecting and screening for SH patients with apparent primary osteoporosis will be addressed.