World Journal of Surgery

, Volume 26, Issue 12, pp 1463–1467 | Cite as

Multifactorial risk profile for bone fractures in primary hyperparathyroidism

  • Erik Nordenström
  • Johan Westerdahl
  • Birger Lindergård
  • Pia Lindblom
  • Anders Bergenfelz
Original Scientific Reports

Abstract

Primary hyperparathyroidism (pHPT) is associated with an increased fracture risk, and decreased bone density thus has been considered an indication for surgery. However, many pHPT patients have a multifactorial risk profile for osteoporosis and bone fractures. The aim of the present study was to evaluate variables associated with fracture risk within the group of pHPT patients. A series of 203 consecutive patients operated for pHPT were investigated with bone mineral content and biochemical and clinical risk factors for bone fracture. Seventeen patients (8%) had a history of at least one bone fracture up to 5 years before pHPT surgery. Twenty-six patients (13%) had a history of at least one fracture during the 10-year period prior to surgery. In the univariate analyses corticosteroid treatment, serum levels of alkaline phosphatase, 25-hydroxyvitamin D3, type I collagen telopeptide, and bone mineral content were found to be associated with a history of bone fractures up to 10 years before surgery. Additionally, age and menopausal status were of importance for fractures during the 10-year-period, whereas a history of cardiovascular disease was important for fractures during the 5-year-period prior to surgery. Multivariate analyses showed that serum level of PTH was independently associated with bone fractures during the 5-year period prior to pHPT surgery and further that serum level of 25-hydroxyvitamin D3 was associated with fractures up to 10 years before surgery. In conclusion, serum levels of 25-hydroxyvitamin D3 and PTH were independently associated with a history of bone fractures in pHPT. These variables should be considered when evaluating patients for parathyroid surgery.

Résumé

L’hyperparathyroïdie primitive (pHPT) est associée à un risque accru de fracture en rapport avec une densité osseuse diminuée et ainsi est considérée comme une bonne indication de la chirurgie. Cependant, beaucoup de patients pHPT ont un profil de risque multifactoriel d’ostéoporose et de fractures. Le but de cette étude a été d’évaluer les variables associées au risque de fracture dans le groupe de patients pHPT. On a évalué chez 203 patients consécutifs opérés pour pHPT le contenu minéral osseux (bone mineral content (BMC)), ainsi que les facteurs de risque de fracture osseuse, biochemique et clinique. Dix-sept patients (8%) avaient une histoire d’au moins une fracture osseuse dans les cinq ans précédant la chirurgie pour pHPT. Vingt-six patients (13%) avaient une histoire d’au moins une fracture osseuse dans les dix ans précédant la chirurgie. Par analyse univariée, on a démontré que le traitement par corticostéroïdes, les niveaux sériques de phosphatases alcalines, les taux de 25-hydroxyvitamine D3, le collagène télopeptide de type I et le BMC étaient associés à une histoire de fracture osseuse dans les dix ans précédant la chirurgie. De même, l’âge et l’état de ménopause étaient des facteurs pronostiques importants dans la période des dix ans précédant la chirurgie alors que la maladie cardiovasculaire était un facteur important dans la période de cinq ans précédant la chirurgie. Par analyse multivariée, on a trouvé que le taux sérique de PTH était un facteur indépendant de fracture osseuse dans la péroide de cinq ans précédant la chirurgie pour pHPT et également, que le taux sérique de 25-hydroxyvitamine D3 était un facteur pronostique indépendant dans la période de dix ans précédant la chirurgie. En conclusion, les taux sériques de la 25-hydroxyvitamine D3 et de la PTH étaient des facteurs de risque indépendants de fracture osseuse en cas de pHPT. Ces données doivent être prises en compte lors de l’évaluation de patients opérés de leur parathyroïde.

Resumen

El hiperparatiroidismo primario (HPTp) se acompañ de riesgo aumentado de fracturas, por lo cual la demostración de densidad ósea disminuida de por sí, ha sido considerada como indicación para cirugía. Sin embargo, muchos pacientes con HPTp tienen un perfil de riesgo de osteoporosis y fracturas óseas multifactorial. El propósito del presente estudio fue evaluar las variables asociadas con riesgo de fracturas en el grupo de pacientes con HPTp. Doscientos tres pacientes consecutivos operados por HPTp fueron estudiados en cuanto a contenido mineral y a factores bioquímicos y clínicos de riesgo de fractura ósea. Diecisiete pacientes (8%) tenían historia de por lo menos una fractura hasta 5 años previos de la cirugía para HPTp. Veintiséis (13%) tenían historia de por lo menos una fractura en el curso de los 10 años anteriores a la cirugía. El análisis multivariado mostró que la terapia con corticoïdes, los niveles séricos de fosfatasa alcalina, de 25 hidroxivitamina D3, el telopéptido colagenoso Tipo ï y el contenido mineral del hueso se asocian con historia de fracturas hasta por 10 años antes de la cirugía. El análisis multivariado mostró que los niveles séricos de paratohormona se hallan independientemente asociados con fracturas óseas en el quinquenio anterior a la cirugía y, además, que los niveles séricos de 25-hidroxivitamina D3 se asocian con fracturas hasta por 10 años previos a la cirugía. En conclusión, los niveles séricos de 25-hidroxivitamina D3 y de paratohormona se hallan independientemente asociados con historia de fracturas óseas en el HPTp. Estas variables deben ser tenidas en cuenta cuando se evalúa un paciente para cirugía paratiroidea.

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Copyright information

© Société Internationale de Chirurgie 2001

Authors and Affiliations

  • Erik Nordenström
    • 1
  • Johan Westerdahl
    • 1
  • Birger Lindergård
    • 2
  • Pia Lindblom
    • 1
  • Anders Bergenfelz
    • 1
  1. 1.Department of SurgeryLund University HospitalLundSweden
  2. 2.Department of Internal MedicineLund University HospitalLundSweden

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