Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Eur J Endocrinol. 2013 Jun 29;169(2):155-62. doi: 10.1530/EJE-13-0305. Print 2013 Aug.
In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture.
We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph.
PHPT patients had lower TBS (-2.39±1.8) and higher VFx prevalence (43.5%) than controls (-0.98±1.07 and 8.2% respectively, both P<0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, P=0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (+47±44.8,+29.2±34.1,+49.4±48.7 and +30.2±39.3% respectively, all P<0.0001). Among patients treated conservatively, TBS decreased significantly in those (n=3) with incident VFx (-1.3±0.3) compared with those without (-0.01±0.9, P=0.048), while BMD changes were not statistically different (LS 0.3±1.2 vs -0.8±0.9 respectively, P=0.19; TH 0.4±0.8 vs -0.8±1.4 respectively, P=0.13 and FN 0.4±0.9 vs -0.8±1.4 respectively, P=0.14).
In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.
在原发性甲状旁腺功能亢进症（PHPT）中，无论骨密度（BMD）如何，都会发生椎体骨折（VFx），并且可能取决于骨质量的降低。骨小梁评分（TBS）是在脊柱双能 X 射线吸收法（DXA）期间获得的纹理测量。最近，TBS 已被提议作为骨微观结构的指标。
我们研究了 92 例 PHPT 患者（74 名女性，年龄 62.1±9.7 岁）和 98 名对照者。在基线时的所有患者中，在 20 例手术治疗的患者和 24 个月后 10 例保守治疗的患者中，通过 DXA 评估 TBS、脊柱（腰椎（LS））和股骨（总髋（TH）和股骨颈（FN））BMD，并通过脊柱 X 光片评估 VFx。
PHPT 患者的 TBS（-2.39±1.8）低于对照组（-0.98±1.07），VFx 的发生率（43.5%）高于对照组（8.2%），均 P<0.0001）。TBS 与 VFx 相关（优势比 1.4，95%CI 1.1-1.9，P=0.02），与 LS-BMD、年龄、BMI 和性别无关，并且在检测 VFx 方面比 LS-BMD、TH-BMD 和 FN-BMD 具有更好的敏感性（75%）和特异性（61.5%）（分别为 31%和 75%，72%和 44.2%，64%和 65%）。在手术治疗的患者中，TBS、LS-BMD、TH-BMD 和 FN-BMD 分别增加（+47±44.8，+29.2±34.1，+49.4±48.7 和+30.2±39.3%，均 P<0.0001）。在保守治疗的患者中，与无 VFx 发生的患者（-0.01±0.9）相比，发生 VFx 的患者（n=3）的 TBS 明显下降（-1.3±0.3，P=0.048），而 BMD 变化无统计学差异（LS 分别为 0.3±1.2 与-0.8±0.9，P=0.19；TH 分别为 0.4±0.8 与-0.8±1.4，P=0.13 和 FN 分别为 0.4±0.9 与-0.8±1.4，P=0.14）。
在 PHPT 中，骨小梁评分（TBS）测量的骨质量降低与 VFx 相关，并在手术后改善。
