Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
J Bone Miner Res. 2018 Sep;33(9):1657-1664. doi: 10.1002/jbmr.3461. Epub 2018 Jun 7.
Prevalence of vertebral fractures (VFx) in primary hyperparathyroidism (PHPT) remains uncertain. We aimed to estimate the prevalence of VFx, investigate potential risk factors associated with VFx, and whether bone mineral density (BMD) differs between PHPT and osteoporotic patients with VFx. Through the Danish National Patient Register, we identified patients diagnosed with PHPT from 2005 to 2015. The diagnosis was verified by reviewing biochemical findings, and X-ray reports were reviewed by two investigators. Osteoporotic patients with VFx were identified from our outpatient clinic and matched on age and sex with PHPT patients with VFx. We identified 792 PHPT patients among whom spine X-ray was available from 588 patients. VFx were present in 122 (21%) patients and were equally frequent among sexes (77% females). Fractured patients were older (70 versus 63 years) and had lower heights (163 versus 166 cm) compared with nonfractured patients (p all < 0.02). After stratification by age groups, the prevalence of VFx differed significantly between sexes (p < 0.01). Ionized calcium and parathyroid hormone did not differ between groups. BMD at total hip and forearm were lower in fractured compared with nonfractured patients (p < 0.03 for both) after adjusting for age, sex, and body mass index (BMI). Compared with osteoporotic patients with VFx (n = 108), BMD at the lumbar spine was higher in PHPT patients with VFx (n = 108) (p < 0.01). This did not change by excluding patients with lumbar VFx (p < 0.01). The severity of PHPT assessed by biochemistry does not seem to be associated with risk of VFx. Compared with osteoporosis, VFx seems to occur at a higher BMD in PHPT. © 2018 American Society for Bone and Mineral Research.
原发性甲状旁腺功能亢进症（PHPT）患者的椎体骨折（VFx）患病率尚不确定。我们旨在评估 VFx 的患病率，研究与 VFx 相关的潜在危险因素，以及 PHPT 患者与 VFx 骨质疏松症患者的骨密度（BMD）是否存在差异。通过丹麦国家患者登记处，我们确定了 2005 年至 2015 年期间诊断为 PHPT 的患者。通过复查生化指标验证了该诊断，并由两名研究者对 X 射线报告进行了复查。在我们的门诊诊所中确定了患有 VFx 的骨质疏松症患者，并与 VFx 患者的 PHPT 患者按年龄和性别进行匹配。我们确定了 792 例 PHPT 患者，其中 588 例患者的脊柱 X 射线可供使用。122 例（21%）患者存在 VFx，且男女发生率相等（女性占 77%）。骨折患者年龄较大（70 岁比 63 岁），身高较低（163 厘米比 166 厘米）（均<0.02）。按年龄组分层后，不同性别间 VFx 的患病率差异具有统计学意义（p<0.01）。各组间离子钙和甲状旁腺激素水平无差异。校正年龄、性别和体重指数（BMI）后，与非骨折患者相比，骨折患者的总髋部和前臂 BMD 均较低（均<0.03）。与患有 VFx 的骨质疏松症患者（n=108）相比，患有 VFx 的 PHPT 患者的腰椎 BMD 更高（n=108）（p<0.01）。当排除腰椎 VFx 患者时，这种情况并没有改变（p<0.01）。通过生化指标评估的 PHPT 的严重程度似乎与 VFx 的风险无关。与骨质疏松症相比，PHPT 患者的 VFx 似乎发生在更高的 BMD 水平。©2018 美国骨矿研究协会。
