Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
J Endocrinol Invest. 2022 Sep;45(9):1777-1786. doi: 10.1007/s40618-022-01818-2. Epub 2022 May 19.
Patients with hypoparathyroidism are at risk of vertebral fractures (VFs) despite high bone mineral density (BMD). We investigated this paradox by assessing trabecular bone score (TBS) and hip structural analysis (HSA) in non-surgical chronic hypoparathyroidism (cHypoPT) with and without VFs.
152 cHypoPT patients (age 40.2 ± 13.4 years, M: F = 81:71) with a median follow-up of 8 (2-13) years were assessed for BMD, VFs, TBS, and HSA and compared with 152 healthy controls. VFs at T-L were assessed by Genant's method. Average serum total calcium and phosphorus during follow-up were assessed.
The lumbar spine and hip BMD were higher by 25.4 and 13.4% in cHypoPT than controls (P < 0.001). Paradoxically, VFs (30.9 vs.7.9%), including multiple (12.5 vs. 2.6%) were higher in cHypoPT (P < 0.001). Though overall average TBS (1.411 ± 0.091) was normal in cHypoPT, 25.4% of the females had subnormal TBS, more in post than pre-menopausal women (52.3 vs. 14%, P = 0.002) and as compared to males (6.1%, P = 0.001). TBS correlated with menopausal status and follow-up serum calcium-phosphorus product. For every gm/cm rise in BMD, TBS increase was only 0.227 in cHypoPT compared to 0.513 in controls. Frequency of VFs increased with declining TBS (P = 0.004). HSA was comparable between cHypoPT with and without VFs. 23.4% of cHypoPT with VFs had subnormal TBS.
31% of cHypoPT patients had VFs. TBS indicated degraded bone microarchitecture in 50% of the post-menopausal cHypoPT women. However, TBS has limitations to detect abnormal bone microarchitecture in cHypoPT as only one-fourth of patients with VFs showed low TBS.
尽管骨密度（BMD）较高，但甲状旁腺功能减退症患者仍存在椎体骨折（VF）的风险。我们通过评估非手术性慢性甲状旁腺功能减退症（cHypoPT）患者的骨小梁评分（TBS）和髋部结构分析（HSA），研究了这一悖论，这些患者有或没有 VF。
评估了 152 例 cHypoPT 患者（年龄 40.2±13.4 岁，M：F=81:71）的 BMD、VF、TBS 和 HSA，并与 152 名健康对照者进行了比较。采用 Genant 法评估 T-L 处的 VF。评估了随访期间的平均血清总钙和磷。
cHypoPT 的腰椎和髋部 BMD 分别高于对照组 25.4%和 13.4%（P<0.001）。矛盾的是，cHypoPT 的 VF（30.9% vs.7.9%）更高，包括多处（12.5% vs.2.6%）（P<0.001）。尽管 cHypoPT 患者的平均 TBS（1.411±0.091）正常，但仍有 25.4%的女性 TBS 偏低，绝经后女性的 TBS 偏低更明显（52.3% vs.14%，P=0.002），而与男性相比（6.1%，P=0.001）。TBS 与绝经状态和随访期间血清钙磷乘积相关。在 cHypoPT 中，每增加 1g/cm BMD，TBS 仅增加 0.227，而在对照组中增加 0.513。随着 TBS 的下降，VF 的发生率也随之增加（P=0.004）。cHypoPT 有或没有 VF 之间的 HSA 无差异。23.4%的有 VF 的 cHypoPT 患者 TBS 偏低。
31%的 cHypoPT 患者存在 VF。TBS 提示 50%的绝经后 cHypoPT 女性存在骨小梁微结构恶化。然而，TBS 有其局限性，无法检测到 cHypoPT 中异常的骨微结构，因为只有四分之一的 VF 患者 TBS 偏低。
