Björnsdottir Sigridur, Kamal Wafa, Mannstadt Michael, Mäkitie Outi, Spelman Tim, Kämpe Olle, Langdahl Bente L
Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden.
Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 171 76 Stockholm, Sweden.
J Bone Miner Res. 2025 Jun 25;40(7):860-867. doi: 10.1093/jbmr/zjaf061.
Patients with chronic hypoparathyroidism (hypoPT) have reduced bone remodeling, leading to increased bone density and abnormalities in microarchitecture and bone strength. Whether these patients have an increased fracture risk remains unclear. This study aimed to evaluate the risk of major osteoporotic fracture (MOF), osteoporosis diagnoses, and osteoporosis medication use in patients with chronic hypoPT in Sweden. Subtypes of fractures were also assessed. Using the Swedish National Patient Register, the Prescribed Drug Register, and the Total Population Register, we identified 1915 patients with chronic hypoPT treated with active vitamin D between 1997 and 2018, and 15 838 matched controls. After adjustment, patients with chronic hypoPT did not have a higher risk of MOF compared to controls (HR 0.93; 95% CI: 0.69-1.26). However, they had a higher risk of vertebral fractures (HR 1.55; 95% CI: 1.12-2.14) and a lower risk of femur fractures (HR 0.70; 95% CI: 0.50-0.98) compared to controls. They were more often diagnosed with osteoporosis (HR 1.54; 95% CI: 1.21-1.95) but less frequently prescribed osteoporosis medication (HR 0.69; 95% CI: 0.54-0.88) compared to controls. No difference in the MOF risk was observed between females and males (p for interaction = 0.872) or between patients with surgical and non-surgical chronic hypoPT (p for interaction = 0.072). In this large Swedish cohort, chronic hypoPT was not associated with an increased risk of MOF. Vertebral fracture risk was higher, while the femur fracture risk was lower compared to controls. Despite higher prevalence of osteoporosis diagnoses, these patients received less frequently osteoporosis medications.
慢性甲状旁腺功能减退症（hypoPT）患者的骨重塑减少，导致骨密度增加、微结构异常和骨强度异常。这些患者的骨折风险是否增加仍不清楚。本研究旨在评估瑞典慢性hypoPT患者发生主要骨质疏松性骨折（MOF）的风险、骨质疏松症诊断情况以及骨质疏松症药物使用情况。还评估了骨折亚型。利用瑞典国家患者登记册、处方药登记册和总人口登记册，我们确定了1997年至2018年间接受活性维生素D治疗的1915例慢性hypoPT患者以及15838例匹配对照。调整后，慢性hypoPT患者发生MOF的风险与对照相比无更高风险（风险比[HR]0.93；95%置信区间[CI]：0.69 - 1.26）。然而，与对照相比，他们发生椎体骨折的风险更高（HR 1.55；95% CI：1.12 - 2.14），发生股骨骨折的风险更低（HR 0.70；95% CI：0.50 - 0.98）。与对照相比，他们更常被诊断为骨质疏松症（HR 1.54；95% CI：1.21 - 1.95），但接受骨质疏松症药物治疗的频率更低（HR 0.69；95% CI：0.54 - 0.88）。在女性和男性之间（交互作用p值 = 0.872）或手术性和非手术性慢性hypoPT患者之间（交互作用p值 = 0.072），未观察到MOF风险存在差异。在这个大型瑞典队列中，慢性hypoPT与MOF风险增加无关。与对照相比，椎体骨折风险更高，而股骨骨折风险更低。尽管骨质疏松症诊断的患病率更高，但这些患者接受骨质疏松症药物治疗的频率更低。
