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Risk of vertebral fractures in hypoparathyroidism

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Abstract

Parathyroid hormone (PTH) exerts both anabolic and catabolic actions on bone,depending on the duration and periodicity of exposure. Hypoparathyroidism is defined by inadequate production of PTH in the presence oflow serum calcium. In hypoparathyroidism it has been reported an increase in corticaland trabecular bone mass, but it is still unknown if these quantitative variations maybe accompanied by qualitative ones and increased bone strength. Despite the extensive data available on the effects of hypoparathyroidism on bone, itseffect on the hard end point in this area which is the risk of fractures still remainsunresolved and highly debated. As a matter of fact no previous review has focused onthis relevant clinical topic. This review will deal with the various aspects of bone metabolism (turn-over,density, quality) in hypoparathyroidism, focusing on the few data available on therisk of fracture and in particular of morphometric vertebral fractures, the emerging way to assess actual skeletal fragility particularly in secondary forms of osteoporosis.

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Abbreviations

PTH:

Parathyroid hormone

CaSR:

Calcium sensing receptor

TGFα:

Transforming growth factor alpha

FGF23:

Fibroblast growth factor 23

RANKL:

Receptor activator of nuclear factor-kappaB ligand

IGF-1:

Insulin-like growth factor 1

TNF:

Tumor necrosis factor

BMD:

Bone mineral density

vBMD:

Volumetric bone mineral density

pQCT:

Peripheral quantitative computed tomography

VF:

Vertebral fractures

DEXA:

Dual-energy X-ray absorptiometery

Ha:

Anterior vertebral height

Hm:

Middle vertebral height

Hp:

Posterior vertebral height

GHD:

Growth hormone deficiency

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Authors and Affiliations

  1. San Raffaele Vita-Salute University Via Olgettina, Milano, Italy

    Anna Maria Formenti, Francesco Tecilazich & Andrea Giustina

  2. University of Brescia, Brescia, Italy

    Raffaele Giubbini

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  1. Anna Maria Formenti
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  2. Francesco Tecilazich
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  3. Raffaele Giubbini
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  4. Andrea Giustina
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Correspondence to Andrea Giustina.

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Author AG has received research grants from Ipsen and Novartis. Author AG is consultant for Ipsen, Pfizer, Astellas, Abiogen and Shire. Author AMF is consultant for Shire and Abiogen. Author FT declares that he has no conflict of interest. Author RG declares that he has no conflict of interest.

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Formenti, A.M., Tecilazich, F., Giubbini, R. et al. Risk of vertebral fractures in hypoparathyroidism. Rev Endocr Metab Disord 20, 295–302 (2019). https://doi.org/10.1007/s11154-019-09507-x

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