title: The threshold of bone mineral density for vertebral fractures in female patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  Primary hyperparathyroidism (pHPT) is one of the causal diseases that induce secondary osteoporosis. Although patients with pHPT have reduced bone mineral density (BMD) especially at the cortical bone, there have been controversies about risk of fracture. Moreover, no reports have been available about the threshold of BMD for fractures in pHPT patients.
  
  
  METHODS
  BMD values were measured by dual-energy x-ray absorptiometry at lumbar spine, femoral neck and distal one third of radius. Various indices were compared in 116 female pHPT patients and 716 control subjects. Moreover, we analyzed relationship between the cut-off values of BMD and the prevalence of vertebral fractures in pHPT and control subjects.
  
  
  RESULTS
  The prevalence of subjects with vertebral fractures was lower in pHPT patients, compared with that of control subjects. Age and body height were significantly higher and lower in pHPT women with vertebral fractures, respectively. Lumbar spine BMD was significantly lower in pHPT women with vertebral fractures, presumably due to their increased age. There were no differences in femoral neck and radius BMD or in bone metabolic indices between pHPT women with and without vertebral fractures. On the other hand, age-matched BMD was not significantly different between both groups at any measured site. Cut-off values of BMD at lumbar spine and femoral neck were lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group. Moreover, cut-off values of BMD at radius was much lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group (pHPT vs control (g/cm(2)): 0.670 vs 0.706 at lumbar spine; 0.549 vs 0.570 at femoral; 0.394 vs 0.474 at radius). Sensitivity and specificity of vertebral fractures was lower in pHPT patients, compared with those in control group.
  
  
  CONCLUSIONS
  The present cross-sectional study demonstrated that thresholds of BMD for vertebral fractures were lower especially at radial bone in female patients with pHPT, compared with those in the control group.
authors.affiliation: Division of Endocrinology/Metabolism, Neurology and Hematology/Oncology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. hiroshik@med.kobe-ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaji
authors.forename: Mika
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chihara
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
mesh_terms: D015502:Absorptiometry, Photon; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000652:urine; D015519:Bone Density / Q000502:physiology*; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000652:urine; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D012372:ROC Curve
chemical_list: D000596:Amino Acids; D010281:Parathyroid Hormone; D015675:Osteocalcin; C036020:deoxypyridinoline; D003404:Creatinine; D000469:Alkaline Phosphatase; D002118:Calcium