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Fracture risk in hypoparathyroidism: a systematic review and meta-analysis

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Abstract

Summary

In this meta-analysis, we analyzed 7 observational studies for assessing the fracture risk in patients with hypoparathyroidism (hypoPT). We found that the risk of vertebral fractures is increased by almost 2-fold, especially those with nonsurgical hypoPT.

Purpose

Patients with hypoPT have higher bone mineral density than age- and sex-matched controls. This would theoretically translate into a lower risk of fractures, although available clinical evidence is contradictory. Hence, the present systematic review and meta-analysis was undertaken to collate and provide a precise summary of fracture risk in hypoPT.

Methods

PubMed, Scopus, and Web of Science databases were systematically searched using appropriate keywords till March 8, 2021, to identify observational studies reporting the rate of occurrence of fractures among hypoPT patients (nonsurgical and/or postsurgical) compared to non-hypoPT subjects (controls). Study quality was assessed using Newcastle-Ottawa Scale. Pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated. Subgroup analyses of nonsurgical and postsurgical hypoPT patients were also conducted.

Results

We identified 7 observational studies of high-quality pooling data retrieved from 1470 patients with hypoPT. When stratified based on the skeletal site, pooled analyses showed that hypoPT patients were at an increased risk of vertebral fractures compared to non-hypoPT controls (OR 2.22, 95% CI: 1.23, 4.03, p = 0.009, I2 = 49%, random-effects model). The increased risk of vertebral fractures was seen only in patients with nonsurgical hypoPT (OR 2.31, 95% CI: 1.32, 4.03, p = 0.003, I2 = 3%, random-effects model) but not in those with postsurgical hypoPT. hypoPT patients were not at an increased or decreased risk of any, humerus, or proximal femur/hip fractures than controls.

Conclusions

Nonsurgical hypoPT patients are at an almost 2-fold increased risk of vertebral fractures and thus need to be actively screened irrespective of the underlying BMD.

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Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    R. Pal, S.K. Bhadada & S. Mukherjee

  2. Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, 700007, India

    M. Banerjee

  3. National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    A. Kumar

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Contributions

Study design was conceived by Sanjay Kumar Bhadada. Literature search and data extraction were performed by Rimesh Pal and Mainak Banerjee. Study quality and risk of bias assessment was performed by Rimesh Pal and Soham Mukherjee. Statistical analysis was performed by Rimesh Pal, Mainak Banerjee, and Ashok Kumar. The initial version of the manuscript was drafted by Rimesh Pal. The manuscript was revised by Sanjay Kumar Bhadada. All authors read and approved the final version of the manuscript.

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Correspondence to S.K. Bhadada.

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Being a meta-analysis, ethical committee approval was not required.

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Supplementary information

Supplementary Figure 1A-C.

Forest plot showing the mean difference (MD) in bone mineral density (BMD) between patients with hypoparathyroidism (hypoPT) and non-hypoPT controls at lumbar spine (Figure S1A), femoral neck (Figure S1B) and total hip (Figure S1C). (JPG 373 kb)

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Pal, R., Bhadada, S., Mukherjee, S. et al. Fracture risk in hypoparathyroidism: a systematic review and meta-analysis. Osteoporos Int 32, 2145–2153 (2021). https://doi.org/10.1007/s00198-021-05966-8

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