原发性甲状旁腺功能亢进症女性患者的骨微结构退化——骨折概率的重要预测指标

Degraded Bone Microarchitecture in Women with PHPT-Significant Predictor of Fracture Probability.

作者信息

Oprea Theodor Eugen, Barbu Carmen Gabriela, Martin Sorina Carmen, Sarbu Anca Elena, Duta Simona Gabriela, Nistor Irina Manuela, Fica Simona

机构信息

Department of Endocrinology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.

Municipal Hospital, Oltenita, Romania.

出版信息

Clin Med Insights Endocrinol Diabetes. 2023 Jan 20;16:11795514221145840. doi: 10.1177/11795514221145840. eCollection 2023.

DOI:10.1177/11795514221145840

PMID:36698384

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9869236/

Abstract

INTRODUCTION

Patients with primary hyperparathyroidism (PHPT) experience bone mineral density (BMD) loss and trabecular bone score (TBS) alteration, which current guidelines recommend assessing. Considering TBS alongside BMD for a 10-year fracture risk assessment (FRAX) may improve PHPT management.

DESIGN

Retrospective, cross-sectional study composed of 49 Caucasian females (62 ± 10.6 years, 27.7 ± 0.87 kg/m) with PHPT and 132 matched control subjects (61.3 ± 10.5 years, 27.5 ± 0.49 kg/m) evaluated in 3 years. We assessed lumbar spine (LS) and femoral neck (FN) BMD, T and Z scores (GE Healthcare Lunar Osteodensitometer) and TBS (iNsight 1.8), major osteoporotic fracture (MOF), and hip FRAX.

RESULTS

Patients with PHPT had statistically lower mean values for lumbar spine bone mineral density (LS BMD) (0.95 ± 0.25 vs 1.01 ± 0.14 g/cm, = .01), LS T-scores (-2 ± 0.2 vs -1.4 ± 0.1 SD, = .009), LS Z scores (-0.9 ± 0.19 vs -0.1 ± 0.11 SD, = .009), femoral neck bone mineral density (FN BMD) (0.79 ± 0.02 vs 0.83 ± 0.01 g/cm, = .02), FN T-scores (-1.8 ± 0.13 vs -1.5 ± 0.07 SD, = .017), FN Z scores (-0.51 ± 0.87 vs -0.1 ± 0.82 SD, = .006), and TBS (0.95 ± 0.25 vs 1.01 ± 0.14 g/cm, = .01) compared with control subjects. 22.4% of patients with PHPT had degraded microarchitecture (TBS < 1.2) vs. 7.6% in control group (χ = 0.008). PHPT proved to be a covariate with unique contribution ( = .031) alongside LS BMD ( = .040) in a linear regression model [ = 0.532, = 4.543] for TBS < 1.2. TBS adjustment elevated MOF FRAX both for PHPT (4.35 ± 0.6% vs 5.25% ± 0.73%, < .001) and control groups (4.5 ± 0.24% vs 4.7% ± 0.26%, < .001) compared with BMD-bases FRAX, but also increased differently between the 2 study groups (1.1-folds for PHPT patients and 1.04 for control subjects, = .034).

CONCLUSION

Compared with control, TBS-adjusted FRAX provides significantly higher MOF risk than BMD-based FRAX in PHPT women.

摘要

引言

原发性甲状旁腺功能亢进症（PHPT）患者存在骨矿物质密度（BMD）降低和小梁骨评分（TBS）改变的情况，目前的指南建议对此进行评估。将TBS与BMD一起用于10年骨折风险评估（FRAX）可能会改善PHPT的管理。

设计

一项回顾性横断面研究，纳入了49名患有PHPT的白种女性（62±10.6岁，体重指数27.7±0.87kg/m）和132名匹配的对照受试者（61.3±10.5岁，体重指数27.5±0.49kg/m），在3年时间内进行评估。我们评估了腰椎（LS）和股骨颈（FN）的BMD、T值和Z值（GE医疗骨密度仪）以及TBS（iNsight 1.8）、主要骨质疏松性骨折（MOF）和髋部FRAX。

结果

与对照受试者相比，PHPT患者的腰椎骨矿物质密度（LS BMD）（0.95±0.25 vs 1.01±0.14g/cm，P=.01）、LS T值（-2±0.2 vs -1.4±0.1标准差，P=.009）、LS Z值（-0.9±0.19 vs -0.1±0.11标准差，P=.009）、股骨颈骨矿物质密度（FN BMD）（0.79±0.02 vs 0.83±0.01g/cm，P=.02）、FN T值（-1.8±0.13 vs -1.5±0.07标准差，P=.017）、FN Z值（-0.51±0.87 vs -0.1±0.82标准差，P=.006）和TBS（0.95±0.25 vs 1.01±0.14g/cm，P=.01）的平均值在统计学上更低。22.4%的PHPT患者存在微结构退化（TBS<1.2），而对照组为7.6%（χ²=0.008）。在TBS<1.2的线性回归模型[R²=0.532，F=4.543]中，PHPT被证明是一个具有独特贡献的协变量（P=.031），与LS BMD（P=.040）一起。与基于BMD的FRAX相比，TBS调整提高了PHPT组（4.35±0.6% vs 5.25%±0.73%，P<.001）和对照组（4.5±0.24% vs 4.7%±0.26%，P<.001）的MOF FRAX，但两个研究组之间的增加幅度也有所不同（PHPT患者为1.1倍，对照受试者为1.04倍，P=.034）。