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Vertebral fractures, trabecular bone score and their determinants in chronic hypoparathyroidism

Authors :
Saha, S.
Mannar, V.
Kandasamy, D.
Sreenivas, V.
Goswami, R.
Source :
Journal of Endocrinological Investigation; September 2022, Vol. 45 Issue: 9 p1777-1786, 10p
Publication Year :
2022

Abstract

Purpose: Patients with hypoparathyroidism are at risk of vertebral fractures (VFs) despite high bone mineral density (BMD). We investigated this paradox by assessing trabecular bone score (TBS) and hip structural analysis (HSA) in non-surgical chronic hypoparathyroidism (cHypoPT) with and without VFs. Methods: 152 cHypoPT patients (age 40.2 ± 13.4 years, M: F= 81:71) with a median follow-up of 8 (2–13) years were assessed for BMD, VFs, TBS, and HSA and compared with 152 healthy controls. VFs at T<subscript>7</subscript>–L<subscript>4</subscript>were assessed by Genant’s method. Average serum total calcium and phosphorus during follow-up were assessed. Results: The lumbar spine and hip BMD were higher by 25.4 and 13.4% in cHypoPT than controls (P< 0.001). Paradoxically, VFs (30.9 vs.7.9%), including multiple (12.5 vs. 2.6%) were higher in cHypoPT (P< 0.001). Though overall average TBS (1.411 ± 0.091) was normal in cHypoPT, 25.4% of the females had subnormal TBS, more in post than pre-menopausal women (52.3 vs. 14%, P= 0.002) and as compared to males (6.1%, P = 0.001). TBS correlated with menopausal status and follow-up serum calcium–phosphorus product. For every gm/cm<superscript>2</superscript>rise in BMD, TBS increase was only 0.227 in cHypoPT compared to 0.513 in controls. Frequency of VFs increased with declining TBS (P= 0.004). HSA was comparable between cHypoPT with and without VFs. 23.4% of cHypoPT with VFs had subnormal TBS. Conclusion: 31% of cHypoPT patients had VFs. TBS indicated degraded bone microarchitecture in 50% of the post-menopausal cHypoPT women. However, TBS has limitations to detect abnormal bone microarchitecture in cHypoPT as only one-fourth of patients with VFs showed low TBS.

Details

Language :
English
ISSN :
03914097 and 17208386
Volume :
45
Issue :
9
Database :
Supplemental Index
Journal :
Journal of Endocrinological Investigation
Publication Type :
Periodical
Accession number :
ejs59857340
Full Text :
https://doi.org/10.1007/s40618-022-01818-2