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Features of patients and fracture risk in hypoparathyroidism; a single center study

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Abstract

Purpose

Patients with hypoparathyroidism (hypoPT) have low bone turnover and high bone mineral density (BMD). However, data on fracture risk are conflicting. The objectives of this study were: 1. To describe clinical/biochemical characteristics of hypoPT patients followed at a single medical center. 2. To identify postsurgical hypoPT patients and investigate their fracture rate compared with gender/age-matched post-surgical normocalcemic patients.

Methods

Retrospective analysis of patient’s medical records treated at the tertiary medical center in 2010–2021 identified by computerized medical database search.

Results

The cohort included 133 patients (91% women, mean age 64 ± 13 years) of whom 105 (79%) had post-thyroidectomy hypoparathyroidism and the remainder had an autoimmune/idiopathic/other etiology. Mean follow-up time was 21 ± 12 and 27 ± 12 years, respectively. The control group included 142 post-thyroidectomy patients without hypoparathyroidism. Patients in the postsurgical hypoparathyroidism group were older and had higher calcium and PTH levels at diagnosis than the non-surgical hypoPT patients. Comparing the postsurgical hypoPT and postsurgical normocalcemic control patients revealed a significantly higher BMD in the hypoPT group. Yet, fracture rates were 31% in the postsurgical hypoparathyroidism group and 21% in the control group (P = 0.1) over a similar median follow-up period (17 and 18.4 years, respectively). In both groups the most common fracture site was the spine (50% and 70%, respectively; p = 0.33), mainly nonclinical morphometric fractures. Higher phosphorus blood level was associated with increased fracture risk.

Conclusions

The relatively high BMD in patients with postsurgical hypoparathyroidism is not associated with lower fracture risk. Silent morphometric fractures are quite common in this group of patients.

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Authors and Affiliations

  1. Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel

    I. Slutzky-Shraga, D. Hirsch, A. Gorshtein, H. Masri-Iraqi, E. Robenshtok, I. Shimon & G. Tsvetov

  2. Statistical Consulting Unit, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel

    T. Shochat

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    D. Hirsch, A. Gorshtein, H. Masri-Iraqi, E. Robenshtok, I. Shimon & G. Tsvetov

  4. Clalit Healthcare Services, Yaffo District, Tel Aviv, Israel

    I. Slutzky-Shraga

  5. Department of Endocrinology, Diabetes & Metabolism, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel

    I. Slutzky-Shraga

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  1. I. Slutzky-Shraga
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Correspondence to I. Slutzky-Shraga.

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The study was performed in accordance with the ethical standards of the responsible committee on human experimentation at the Rabin Medical Center and Israel, and with the Helsinki declaration of 1964 and later versions.

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Slutzky-Shraga, I., Hirsch, D., Gorshtein, A. et al. Features of patients and fracture risk in hypoparathyroidism; a single center study. J Endocrinol Invest 47, 593–601 (2024). https://doi.org/10.1007/s40618-023-02177-2

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  • DOI: https://doi.org/10.1007/s40618-023-02177-2

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