The Risk of Fractures in Primary Hyperparathyroidism: A Meta‐Analysis

Abstract

Primary hyperparathyroidism (PHPT) is a common metabolic bone disease affecting 1% of the adult population. Patients with PHPT have reduced BMD, especially at the cortical bone. However, studies evaluating its impact on fracture risk have shown contradictory results. In an effort to further inform fracture risk for this patient population, a meta‐analysis of studies of fracture in patients with PHPT compared with a control population was undertaken. Articles were searched in PubMed/MEDLINE, Excerpta Medica, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Web of Science bibliographic databases. The meta‐analysis included 17 studies involving 3807 PHPT cases and 11,908 controls. The primary outcome was to determine the risk of vertebral fracture (VF), nonvertebral fracture, hip fracture, distal radius fracture, and total fracture (TF) among patients with PHPT in comparison with a control population. BMD (lumbar spine, femoral neck, total hip, and distal radius) and serum 25‐hydroxy vitamin D level, as well as possible predictors of VF as secondary outcomes were assessed. From this meta‐analysis, it was found that there was a significantly increased risk of VF (risk ratio [RR], 2.57; 95% CI, 1.3–5.09; p = 0.007) and TF (RR, 1.71; 95% CI, 1.48–1.97; p < 0.00001) in patients with PHPT. There was a significant decrease in BMD in patients with PHPT versus controls at all four sites. Older age, longer duration since menopause, and lower BMD at lumbar spine and distal radius were predictors for VF. To conclude, patients with PHPT had a significantly higher risk for VF and TF in comparison with controls. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery?

“…Some evaluation tools such as the numerical rating scale and Harris Hip Scale were subjective. Further, other patient characteristics such as muscle strength and hyperparathyroidism, which are associated with vitamin D deficiency, may affect mortality [ 33 – 35 ] and should be considered as a reference for predicting patient outcome. Lastly, there may be some selection bias, patients with extremely poor postoperative recovery, absence of rehabilitation willingness, or those dependent on life support systems cannot participate in the PAC program.…”

Differences in the global exposure, mortality and disability of low bone mineral density between men and women: the underestimated burden in men

“…Women aged over 70 years old have experienced long-term deficiency of estrogen, and overactivated activated osteoclasts and enhanced resorptive function are the main cause for bone loss in the absence of estrogen, which leads to osteoporosis [ 9 ]. Besides, the rate of hyperparathyroidism in postmenopausal women is also higher, which leads to hypercalcemia and bone diseases [ 10 , 11 ]. A third reason is that women tend to live significantly longer than men, and the absolute number of osteoporosis in older women reached six times as many as that of men due to the higher proportion of women of advanced age [ 12 ].…”

Pathological subtrochanteric fracture revealing a primary hyperparathyroidism: A case report

“…The preferential localization of “brown tumors” is the mandible, the ribs, the clavicle, and finally the large bones such as the pelvis and skull [10] . Primary hyperparathyroidism is associated with an increased risk of vertebral and non-vertebral fractures due to a reduction of volumetric densities at both cortical and trabecular compartments including patients with mild hyperparathyroidism [11] , [12] . The fracture rate in patients with primary hyperparathyroidism has been reported to be approximately 15 per 1000 person years [13] .…”