Degraded Bone Microarchitecture in Women with PHPT-Significant Predictor of Fracture Probability

Theodor Eugen Oprea; Carmen Gabriela Barbu; Sorina Carmen Martin; Anca Elena Sarbu; Simona Gabriela Duta; Irina Manuela Nistor; Simona Fica

doi:10.1177/11795514221145840

Degraded Bone Microarchitecture in Women with PHPT-Significant Predictor of Fracture Probability

Clin Med Insights Endocrinol Diabetes. 2023 Jan 20:16:11795514221145840. doi: 10.1177/11795514221145840. eCollection 2023.

Authors

Theodor Eugen Oprea^{1

2}, Carmen Gabriela Barbu^{1

3}, Sorina Carmen Martin^{1

3}, Anca Elena Sarbu^{1

3}, Simona Gabriela Duta³, Irina Manuela Nistor¹, Simona Fica^{1

3}

Affiliations

¹ Department of Endocrinology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
² Municipal Hospital, Oltenita, Romania.
³ Department of Endocrinology, Elias University and Emergency Hospital, Bucharest, Romania.

Abstract

Introduction: Patients with primary hyperparathyroidism (PHPT) experience bone mineral density (BMD) loss and trabecular bone score (TBS) alteration, which current guidelines recommend assessing. Considering TBS alongside BMD for a 10-year fracture risk assessment (FRAX) may improve PHPT management.

Design: Retrospective, cross-sectional study composed of 49 Caucasian females (62 ± 10.6 years, 27.7 ± 0.87 kg/m²) with PHPT and 132 matched control subjects (61.3 ± 10.5 years, 27.5 ± 0.49 kg/m²) evaluated in 3 years. We assessed lumbar spine (LS) and femoral neck (FN) BMD, T and Z scores (GE Healthcare Lunar Osteodensitometer) and TBS (iNsight 1.8), major osteoporotic fracture (MOF), and hip FRAX.

Results: Patients with PHPT had statistically lower mean values for lumbar spine bone mineral density (LS BMD) (0.95 ± 0.25 vs 1.01 ± 0.14 g/cm², P = .01), LS T-scores (-2 ± 0.2 vs -1.4 ± 0.1 SD, P = .009), LS Z scores (-0.9 ± 0.19 vs -0.1 ± 0.11 SD, P = .009), femoral neck bone mineral density (FN BMD) (0.79 ± 0.02 vs 0.83 ± 0.01 g/cm², P = .02), FN T-scores (-1.8 ± 0.13 vs -1.5 ± 0.07 SD, P = .017), FN Z scores (-0.51 ± 0.87 vs -0.1 ± 0.82 SD, P = .006), and TBS (0.95 ± 0.25 vs 1.01 ± 0.14 g/cm², P = .01) compared with control subjects. 22.4% of patients with PHPT had degraded microarchitecture (TBS < 1.2) vs. 7.6% in control group (χ² = 0.008). PHPT proved to be a covariate with unique contribution (P = .031) alongside LS BMD (P = .040) in a linear regression model [R ² = 0.532, F(4,16) = 4.543] for TBS < 1.2. TBS adjustment elevated MOF FRAX both for PHPT (4.35 ± 0.6% vs 5.25% ± 0.73%, P < .001) and control groups (4.5 ± 0.24% vs 4.7% ± 0.26%, P < .001) compared with BMD-bases FRAX, but also increased differently between the 2 study groups (1.1-folds for PHPT patients and 1.04 for control subjects, P = .034).

Conclusion: Compared with control, TBS-adjusted FRAX provides significantly higher MOF risk than BMD-based FRAX in PHPT women.

Keywords: 10-year probability of fracture; Primary hyperparathyroidism; degraded microarchitecture; osteoporosis; trabecular bone score.