Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women.
BACKGROUND
Primary hyperparathyroidism (PH) is characterized by inappropriate PTH elevation with or without hypercalcemia. Bone disease involves catabolic action at cortical sites, whereas cancellous sites and geometry might be relatively preserved.


OBJECTIVE
Our objective was to examine the effect of PH on quantitative and qualitative bone characteristics using peripheral quantitative computed tomography at the tibia in postmenopausal women with PH and healthy controls.


METHODS
We conducted a cross-sectional study at a tertiary referral center.


METHODS
Fifty-two postmenopausal women with PH and 56 healthy controls, comparable for age and anthropometric measures, participated.


METHODS
There was no intervention.


METHODS
We assessed volumetric bone mineral density (vBMD), bone mineral content (BMC), cortical thickness, cortical and trabecular area, peri- and endosteal circumference, and polar stress strength index assessed by peripheral quantitative computed tomography of the left tibia at 4% (cancellous), 14% (transition zone), and 38% (cortical) from the distal end.


RESULTS
At 4%, there was a significant decrease of trabecular BMC and vBMD (P < 0.001), effect particularly evident in hypercalcemic patients, whereas trabecular area was comparable. At 38%, cortical BMC (P < 0.01), vBMD (P < 0.01), area (P < 0.05), and thickness (P < 0.001) were reduced in the PH group, particularly in hypercalcemic patients. Endosteal circumference increased (P < 0.001), whereas periosteal circumference was comparable, indicating cancellization of cortical bone. At 14%, polar stress strength index was significantly decreased (P < 0.01) in hypercalcemic patients, indicating impairment of bone mechanical properties.


CONCLUSIONS
Normocalcemic PH is characterized by catabolic actions at both cortical and cancellous sites (38 and 4%, respectively), an effect accentuated in hypercalcemic patients. Cortical geometric properties are adversely affected even in normocalcemic patients, whereas trabecular properties are generally preserved.
Laboratory for Research of Musculoskeletal System, University of Athens, KAT Hospital, 14561 Athens, Greece.
Ioannis
I
Charopoulos
Symeon
S
Tournis
George
G
Trovas
Panagiota
P
Raptou
Philippos
P
Kaldrymides
Gregory
G
Skarandavos
Katerina
K
Katsalira
George P
GP
Lyritis
D015502:Absorptiometry, Photon; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D017698:Postmenopause / Q000378:metabolism*; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
D010281:Parathyroid Hormone