Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, 700007, India.
Osteoporos Int. 2021 Nov;32(11):2145-2153. doi: 10.1007/s00198-021-05966-8. Epub 2021 May 22.
In this meta-analysis, we analyzed 7 observational studies for assessing the fracture risk in patients with hypoparathyroidism (hypoPT). We found that the risk of vertebral fractures is increased by almost 2-fold, especially those with nonsurgical hypoPT.
Patients with hypoPT have higher bone mineral density than age- and sex-matched controls. This would theoretically translate into a lower risk of fractures, although available clinical evidence is contradictory. Hence, the present systematic review and meta-analysis was undertaken to collate and provide a precise summary of fracture risk in hypoPT.
PubMed, Scopus, and Web of Science databases were systematically searched using appropriate keywords till March 8, 2021, to identify observational studies reporting the rate of occurrence of fractures among hypoPT patients (nonsurgical and/or postsurgical) compared to non-hypoPT subjects (controls). Study quality was assessed using Newcastle-Ottawa Scale. Pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated. Subgroup analyses of nonsurgical and postsurgical hypoPT patients were also conducted.
We identified 7 observational studies of high-quality pooling data retrieved from 1470 patients with hypoPT. When stratified based on the skeletal site, pooled analyses showed that hypoPT patients were at an increased risk of vertebral fractures compared to non-hypoPT controls (OR 2.22, 95% CI: 1.23, 4.03, p = 0.009, I = 49%, random-effects model). The increased risk of vertebral fractures was seen only in patients with nonsurgical hypoPT (OR 2.31, 95% CI: 1.32, 4.03, p = 0.003, I = 3%, random-effects model) but not in those with postsurgical hypoPT. hypoPT patients were not at an increased or decreased risk of any, humerus, or proximal femur/hip fractures than controls.
Nonsurgical hypoPT patients are at an almost 2-fold increased risk of vertebral fractures and thus need to be actively screened irrespective of the underlying BMD.
甲状旁腺功能减退症(hypoPT)患者的骨密度高于年龄和性别匹配的对照组。从理论上讲,这会降低骨折的风险,尽管现有临床证据存在矛盾。因此,进行了这项系统评价和荟萃分析,以收集和提供 hypoPT 患者骨折风险的准确总结。
使用适当的关键字,系统地搜索了 PubMed、Scopus 和 Web of Science 数据库,直到 2021 年 3 月 8 日,以确定报告 hypoPT 患者(手术和/或手术后)与非 hypoPT 患者(对照组)骨折发生率的观察性研究。使用纽卡斯尔-渥太华量表评估研究质量。计算了合并的优势比(OR)和 95%置信区间(CI)。还进行了非手术和手术后 hypoPT 患者的亚组分析。
我们确定了 7 项高质量的观察性研究,这些研究的数据来自 1470 名 hypoPT 患者。当根据骨骼部位进行分层时,汇总分析表明,与非 hypoPT 对照组相比,hypoPT 患者发生椎体骨折的风险增加(OR 2.22,95%CI:1.23,4.03,p = 0.009,I = 49%,随机效应模型)。仅在非手术 hypoPT 患者中观察到椎体骨折风险增加(OR 2.31,95%CI:1.32,4.03,p = 0.003,I = 3%,随机效应模型),而在手术后 hypoPT 患者中则没有。与对照组相比,hypoPT 患者发生任何、肱骨或股骨近端/髋部骨折的风险既没有增加也没有降低。
非手术 hypoPT 患者发生椎体骨折的风险几乎增加了 2 倍,因此无论基础 BMD 如何,都需要积极筛查。