title: Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture.
  
  
  METHODS
  We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph.
  
  
  RESULTS
  PHPT patients had lower TBS (-2.39±1.8) and higher VFx prevalence (43.5%) than controls (-0.98±1.07 and 8.2% respectively, both P<0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, P=0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (+47±44.8,+29.2±34.1,+49.4±48.7 and +30.2±39.3% respectively, all P<0.0001). Among patients treated conservatively, TBS decreased significantly in those (n=3) with incident VFx (-1.3±0.3) compared with those without (-0.01±0.9, P=0.048), while BMD changes were not statistically different (LS 0.3±1.2 vs -0.8±0.9 respectively, P=0.19; TH 0.4±0.8 vs -0.8±1.4 respectively, P=0.13 and FN 0.4±0.9 vs -0.8±1.4 respectively, P=0.14).
  
  
  CONCLUSIONS
  In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.
authors.affiliation: Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Marcello
authors.initials: M
authors.lastname: Filopanti
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Ulivieri
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Volha V
authors.initials: VV
authors.lastname: Zhukouskaya
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.forename: Rosa
authors.initials: R
authors.lastname: Pino
authors.forename: Antonella
authors.initials: A
authors.lastname: Naccarato
authors.forename: Uberta
authors.initials: U
authors.lastname: Verga
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*