title: Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology.
abstract: BACKGROUND
  The fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism (PHPT) has recently suggested that skeletal and renal imaging be routinely conducted. So far, no study has systematically assessed this issue.
  
  
  OBJECTIVE
  The objective was to evaluate the prevalence of kidney stones (KS) and vertebral fractures (VFs) in a cohort of patients with PHPT utilizing noninvasive imaging technology.
  
  
  METHODS
  This was a prospective study evaluating patients consecutively diagnosed with PHPT in a single center over a 5-year period (2009-2013).
  
  
  METHODS
  The setting was a referral center.
  
  
  METHODS
  There were a total of 140 patients with PHPT (127 women [18 premenopausal and 109 postmenopausal] and 13 men; mean age, 63.2 ± 11 y).
  
  
  METHODS
  Main outcome measures were the prevalence of KS by abdominal ultrasound, osteoporosis by dual-energy x-ray absorptiometry (DXA) (lumbar spine, femoral neck, total hip, and distal 1/3 radius), and VFs by vertebral spine x-ray, with attention to those categorized as symptomatic or asymptomatic.
  
  
  RESULTS
  Fifty-five percent of all subjects had KS by ultrasound, 62.9% had osteoporosis by T-score at any site, and 35.1% had VFs by x-ray. There was no difference in the incidence of VFs and densitometric osteoporosis between symptomatic and asymptomatic patients (VFs, 34.4 vs 34.7%; osteoporosis by DXA, 59.4 vs 65.8%), whereas more KS were detected in symptomatic (78%) than asymptomatic (35.5%). Twenty-two percent of patients classified as asymptomatic at baseline without osteoporosis by DXA were found to have KS and/or VFs.
  
  
  CONCLUSIONS
  Nephrolithiasis and VFs are common in asymptomatic subjects with PHPT. The results provide evidence in support of recent recommendations that a more proactive approach be taken to detect silent bone and stone disease in asymptomatic PHPT.
authors: Department of Internal Medicine and Medical Disciplines (C.C., F.B., P.B., J.P., S.P., S.M.), "Sapienza" University of Rome, 00161 Rome, Italy; Metabolic Bone Diseases Unit (C.C., A.G.C., C.Z., J.P.B.), Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032; Department of Medicine (A.G.C.), Division of Endocrinology, São Paulo Federal University, São Paulo 04021-001, Brazil; Department of Radiology (D.D.), "Sapienza" University of Rome, 00161, Rome, Italy; and Unit of Endocrinology (A.S.), "Casa Sollievo della Sofferenza" Hospital, Instituto di Ricovero e Cura a Carattere Scientifico, 71013 San Giovanni Rotondo FG, Italy.
authors: Cristiana
authors: C
authors: Cipriani
authors: Federica
authors: F
authors: Biamonte
authors: Aline G
authors: AG
authors: Costa
authors: Chiyuan
authors: C
authors: Zhang
authors: Piergianni
authors: P
authors: Biondi
authors: Daniele
authors: D
authors: Diacinti
authors: Jessica
authors: J
authors: Pepe
authors: Sara
authors: S
authors: Piemonte
authors: Alfredo
authors: A
authors: Scillitani
authors: Salvatore
authors: S
authors: Minisola
authors: John P
authors: JP
authors: Bilezikian
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011884:Radius / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014463:Ultrasonography
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