Risk factors for vertebral fracture in primary hyperparathyroidism
Screening for vertebral fractures (VF) in primary hyperparathyroidism (PHPT) is recommended, but there are limited data regarding which patients are at greatest risk for VF. We evaluated risk factors for VF in PHPT.
This is a retrospective cross-sectional analysis of 117 participants with PHPT. We assessed Grades 2 and 3 VF by vertebral fracture assessment (VFA) and the association of VF with the trabecular bone score (TBS), other skeletal parameters and clinical risk factors. VFA was performed only in those who met National Osteoporosis Foundation criteria for VFA screening.
T-scores were in the osteopenic range and TBS was degraded. Overall VF rate based on VFA or other imaging was 12.8%. Serum PTH, calcium and TBS were not associated with VF. Those with VF were older (p = 0.04), had worse renal function (p = 0.04), were more likely to have received osteoporosis treatment (p = 0.03), and tended to have had a prior fracture (p = 0.06). T-scores did not differ by fracture status at any skeletal site. Those with VF had nine times the odds of osteoporosis at the hip (95% CI 2.4–34.5), but this risk factor had low sensitivity (46.7%) for VF. Hip T-score < −2.6, Age > 78.6 years, and GFR < 58.8 ml/min/1.73 m2 (thresholds maximizing sensitivity and specificity) had areas under the curve of 0.60–0.67 for VF (all p < 0.05) and low sensitivity. Findings were similar when analyses were limited to women.
In PHPT, VF risk factors included older age, prior fracture, worse renal function and osteoporosis at the hip, but not osteoporosis at other sites, TBS or biochemical indices of PHPT. Since identified risk factors had low sensitivity and were generally inaccurate for categorizing those with VF, the data do not support limiting screening to PHPT patients with these specific VF risk factors.
KeywordsPrimary hyperparathyroidism Vertebral fractures TBS Prevalence
This study was funded by the Endocrine Fellows Foundation, T32 DK007271.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The Columbia University Medical Center Institutional Review Board granted a waiver of consent (45 CFR 46.116) for this study as this was a retrospective chart review of historical patients, the study involved no more than minimal risk to participants, the waiver did not adversely affect the rights and welfare of the subjects, and the research could not practicably be carried out without the waiver.
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