High Bone Density Found in Women With Hypoparathyroidism

Marlene Busko, for Medscape

November 03, 2022

The study covered in this summary was published on Research Square as a preprint has not yet been peer reviewed.

Key Takeaway

  • Among women with hypoparathyroidism, bone mineral density (BMD) was increased, and there was no increase in fracture risk nor in fracture prevalence compared with matched control women with normal levels of parathyroid hormone in a cross-sectional, case-control study that involved 71 women.

Why This Matters

  • Few previous studies assessed fracture risk in people with hypoparathyroidism, and reported studies have had contradictory findings. Chronic deficiency of parathyroid hormone (PTH) results in increased bone mass and improved bone strength, which could reduce fracture risk. But low PTH levels causes low bone turnover, which may cause bones to be fragile, thereby increasing the risk of microdamage.

  • The study collected data on bone geometry and microarchitecture with high-resolution peripheral quantitative CT (HR-pQCT). Few prior studies have used this method for bone assessment of people with hypoparathyroidism.

Study Design

  • The researchers enrolled at their single center in Brazil 27 patients with postsurgical permanent hypoparathyroidism and 44 control women who were matched for body mass index (BMI) and age.

  • The researchers assessed whether the participants had previously experienced clinical fractures through the use of questionnaires and by reviewing medical records, and they estimated 10-year fracture risk using a Fracture Risk Assessment (FRAX) tool designed for a Brazilian population.

  • Dual-energy x-ray absorptiometry was used to assess areal BMD at the lumbar spine, femoral neck, and total hip. HR-pQCT of the distal forearm and tibia was used to assess bone volumetric density and microarchitecture. Blood and 24-hour urine samples were taken for analysis of multiple biochemical parameters.

Key Results

  • Among the 27 women with hypoparathyroidism, 16 had undergone thyroidectomy for noncancerous goiter, nine for thyroid cancer, and two for Graves disease. They had had hypoparathyroidism for an average of 8 years, and 78% were postmenopausal.

  • For all the women with hypoparathyroidism, fracture probability estimates were below the intervention limit, as determined using the National Osteoporosis Guidelines Group calculator. Two of these patients presented with morphometric vertebral fractures.

  • Among the women with hypoparathyroidism, areal BMD was higher compared with control participants at all sites examined; the highest values were in the lumbar spine. Cortical volumetric BMD was higher at the distal radius and tibia, as evaluated by HR-pQCT.

  • Among those with hypoparathyroidism, levels of circulating markers of bone resorption and bone formation were low, but there was no correlation between BMD or HR-pQCT measurements and these markers.

Limitations

  • This was a cross-sectional study involving a modest number of people with hypoparathyroidism.

  • The analysis excluded consideration of previous mild fractures, but these are less relevant for predicting future fractures.

Disclosures

  • The study was funded by Shire/Takeda.

  • The authors have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "Chronic Hypoparathyroidism Is Associated With Increased Cortical Bone Density Evaluated by High Resolution Peripheral Quantitative Computed Tomography," written by researchers from Universidade Federal de Rio de Janeiro, Brazil, published on Research Square, and provided to you by Medscape. The study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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