title: Parathyroid-hormone variance is only marginally explained by a panel of determinants: a cross-sectional study of 909 hip-fracture patients.
abstract: Several factors affect the levels of parathyroid hormone (PTH) in hip-fracture patients. We hypothesized that a panel of easily assessable determinants could account for both a substantial proportion of PTH variance and the occurrence of secondary hyperparathyroidism. We evaluated 909 of 981 hip-fracture inpatients admitted consecutively to our Rehabilitation division. In each patient we assessed PTH, 25-hydroxyvitamin D, albumin-adjusted total calcium, phosphate, magnesium, and creatinine on a fasting blood sample 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Glomerular filtration rate (GFR) was estimated by the 4-variable Modification of Diet in Renal Disease Study equation. Functional level was assessed using the Barthel index. On multivariate analysis, six factors (phosphate, albumin-adjusted total calcium, estimated GFR (eGFR), 25-hydroxyvitamin D, age, and magnesium) were significantly associated with PTH levels. Overall, the panel of variables accounted for 23.7 % of PTH variance. Among the 909 patients, 304 (33.4 %) had PTH levels exceeding the normal range. Six factors (phosphate, albumin-adjusted total calcium, eGFR, 25-hydroxyvitamin D, age, and Barthel index scores) were significantly associated with the category of PTH level (either normal or elevated). The model correctly classified 70.4 % of cases. For the optimal cut-off point, sensitivity was 80 % and specificity was 61 %. Data shows that six factors were significantly associated with PTH levels in hip-fracture inpatients. However, the six factors accounted for only 23.7 % of PTH variance and the presence or absence of secondary hyperparathyroidism was correctly categorized in a modest proportion of cases. We conclude that more knowledge is needed on the factors affecting PTH levels after hip fracture.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131, Turin, Italy, marco.di.monaco@alice.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Monaco
authors.forename: Carlotta
authors.initials: C
authors.lastname: Castiglioni
authors.forename: Fulvia
authors.initials: F
authors.lastname: Vallero
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Monaco
authors.forename: Rosa
authors.initials: R
authors.lastname: Tappero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006620:Hip Fractures / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*; D012372:ROC Curve
chemical_list: D010281:Parathyroid Hormone