title: Functional hypoparathyroidism in postmenopausal women with fragility fracture.
abstract: BACKGROUND
  Secondary hyperparathyroidism sometimes is lacking despite authentic vitamin D insufficiency (VDI) and the concept of functional hypoparathyroidism with a protective role on bone status has been proposed. Therefore, we tested the hypothesis that its prevalence was very low in a population of women with a peripheral fragility fracture.
  
  
  METHODS
  We conducted our study in postmenopausal women, admitted for such a fracture in our Fracture Liaison Service. All had bone mineral density (BMD), biochemical assessment and a medical visit.
  
  
  RESULTS
  Two hundred and thirty seven women (72.9±11.6-year-old) were included and 90.4% had VDI (25[OH]D≤30 ng/mL). Yet, 87.9% of the latter had normal PTH levels less or equal to 64 ng/L. In this population with VDI (n=214), we found no PTH plateau level related to 25(OH)D. Since a recent study reported an increase in the risk of fracture only when 25(OH)D was below 15 ng/mL, we then used this value as a new threshold. We observed a significant difference in hip BMD between patients with 25(OH)D either less or equal to or greater than 15 ng/mL. However, 81.2% of the formers were still with normal PTH with no difference in BMD whether PTH level was above or within normal range.
  
  
  CONCLUSIONS
  In a population of postmenopausal women with a fragility fracture, we found that 25(OH)D less or equal to 15 ng/mL was associated with significantly lower hip BMD. Even using this low threshold, we found a high prevalence of functional hypoparathyroidism and it was not associated with any difference in hip or spine BMD. Overall, our results do not support the hypothesis of a protective effect of this biological profile.
authors.affiliation: Inserm U1059, Rheumatology Department, University Hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: Adamah
authors.initials: A
authors.lastname: Amouzougan
authors.forename: Florence
authors.initials: F
authors.lastname: Chopin
authors.forename: Silvy
authors.initials: S
authors.lastname: Laporte
authors.forename: Laurence
authors.initials: L
authors.lastname: Vico
authors.forename: Thierry
authors.initials: T
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007011:Hypoparathyroidism / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood; D017698:Postmenopause; D015995:Prevalence; D012189:Retrospective Studies; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D