Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism.
BACKGROUND
An increased risk of fracture in patients with primary hyperparathyroidism (PHPT) compared to the general population has been reported, but available data are controversial.


OBJECTIVE
The aim of the study was to evaluate the rate of vertebral fractures (VFs) by dual-energy x-ray absorptiometry in postmenopausal women with sporadic PHPT and compare the results with a control group.


METHODS
A case-control study was performed at a referral center.


METHODS
A total of 150 consecutive patients and 300 healthy women matched for age and menopausal age participated in the study.


RESULTS
VFs were detected in 37 of 150 (24.6%) patients and 12 of 300 (4.0%) controls (P < 0.0001). The majority of VFs were mild. Stepwise multiple logistic regression analysis showed that in PHPT patients lumbar spine bone mineral density was the only variable independently associated with the prevalence of VFs (P = 0.003). The rate of fracture was higher in symptomatic (34.1%) than asymptomatic (21.1%) patients, but this difference was not statistically significant (P = 0.15). Among asymptomatic patients, fracture rate was significantly higher in those who met the criteria for parathyroidectomy (28.1%) than in those who did not (11.1%) (P = 0.03). Compared to controls, the fracture rate was significantly higher in patients with symptomatic and asymptomatic PHPT who met the criteria for surgery (P < 0.0001), but not in those who did not meet the criteria (P = 0.06).


CONCLUSIONS
VF rate is increased in postmenopausal women with PHPT compared to controls, independently of whether they are classified as symptomatic or asymptomatic. The question of whether the finding of mild morphometric VFs in the latter represents an indication for parathyroid surgery remains to be established.
Vignali
Edda
E
Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy.
Viccica
Giuseppe
G
Diacinti
Daniele
D
Cetani
Filomena
F
Cianferotti
Luisella
L
Ambrogini
Elena
E
Banti
Chiara
C
Del Fiacco
Romano
R
Bilezikian
John P
JP
Pinchera
Aldo
A
Marcocci
Claudio
C
D000368:Aged; D000465:Algorithms; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D054928:Validation Studies as Topic