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Parathyroid-hormone variance is only marginally explained by a panel of determinants: a cross-sectional study of 909 hip-fracture patients

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Abstract

Several factors affect the levels of parathyroid hormone (PTH) in hip-fracture patients. We hypothesized that a panel of easily assessable determinants could account for both a substantial proportion of PTH variance and the occurrence of secondary hyperparathyroidism. We evaluated 909 of 981 hip-fracture inpatients admitted consecutively to our Rehabilitation division. In each patient we assessed PTH, 25-hydroxyvitamin D, albumin-adjusted total calcium, phosphate, magnesium, and creatinine on a fasting blood sample 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Glomerular filtration rate (GFR) was estimated by the 4-variable Modification of Diet in Renal Disease Study equation. Functional level was assessed using the Barthel index. On multivariate analysis, six factors (phosphate, albumin-adjusted total calcium, estimated GFR (eGFR), 25-hydroxyvitamin D, age, and magnesium) were significantly associated with PTH levels. Overall, the panel of variables accounted for 23.7 % of PTH variance. Among the 909 patients, 304 (33.4 %) had PTH levels exceeding the normal range. Six factors (phosphate, albumin-adjusted total calcium, eGFR, 25-hydroxyvitamin D, age, and Barthel index scores) were significantly associated with the category of PTH level (either normal or elevated). The model correctly classified 70.4 % of cases. For the optimal cut-off point, sensitivity was 80 % and specificity was 61 %. Data shows that six factors were significantly associated with PTH levels in hip-fracture inpatients. However, the six factors accounted for only 23.7 % of PTH variance and the presence or absence of secondary hyperparathyroidism was correctly categorized in a modest proportion of cases. We conclude that more knowledge is needed on the factors affecting PTH levels after hip fracture.

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Authors and Affiliations

  1. Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131, Turin, Italy

    Marco Di Monaco, Carlotta Castiglioni, Fulvia Vallero & Rosa Tappero

  2. Department of Social Science, University of Turin, Via Sant’Ottavio 50, 10124, Turin, Italy

    Roberto Di Monaco

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  1. Marco Di Monaco
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  2. Carlotta Castiglioni
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  3. Fulvia Vallero
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  4. Roberto Di Monaco
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  5. Rosa Tappero
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Correspondence to Marco Di Monaco.

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Di Monaco, M., Castiglioni, C., Vallero, F. et al. Parathyroid-hormone variance is only marginally explained by a panel of determinants: a cross-sectional study of 909 hip-fracture patients. J Bone Miner Metab 32, 573–579 (2014). https://doi.org/10.1007/s00774-013-0532-z

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  • DOI: https://doi.org/10.1007/s00774-013-0532-z

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