nach oben

Osteoporosis International

Erschienen in:

01.02.2021 | Review

Risk of fractures in primary hyperparathyroidism: a systematic review and meta-analysis

verfasst von: H. Ejlsmark-Svensson, L. Rolighed, T. Harsløf, L. Rejnmark

Erschienen in: Osteoporosis International | Ausgabe 6/2021

Einloggen, um Zugang zu erhalten

Abstract

An increased risk of fractures in primary hyperparathyroidism (PHPT) has been reported in a number of relatively small studies. Performing a systematic literature search, we identified available studies and calculated common estimates by pooling results from the individual studies in a meta-analysis. Searching EMBASE and PubMed, we identified published studies reporting the risk of fractures in PHPT compared to a control group. We calculated odds ratio (OR) with 95% confidence interval (CI). A total of 804 studies were identified of which 12 studies were included. Risk of any fracture was increased compared to controls (OR 2.01; 95% CI, 1.61-2.50; I² 46%, 5 studies). Analysis of fracture risk at specific sites showed an increased risk of fracture at the forearm (OR 2.36; 95% CI, 1.64-3.38; I² 0%, 4 studies) and spine (OR 3.00; 95% CI, 1.41, 6.37, I² 88%, 9 studies). Risk estimate for hip fractures was non-significantly increased (OR 1.27; 95% CI, 0.97-1.66; I² 0%, 3 studies). Risk of vertebral fractures (VFx) was also increased if analyses were restricted to only studies with a healthy control group (OR 5.76; 95% CI, 3.86-8.60; I² 29%, 6 studies), studies including patients with mild PHPT (OR 4.22; 95% CI, 2.20-8.12; I² 57%, 4 studies) or studies including postmenopausal women (OR 8.07; 95% CI, 4.79-13.59; I² 0%, 3 studies). PHPT is associated with an increased risk of fractures. Although a number of studies are limited—it seems that the risk is increased across different skeletal sites including patients with mild PHPT and postmenopausal women.

Fraser WD (2009) Hyperparathyroidism. Lancet 374:145–158. https://doi.org/10.1016/S0140-6736(09)60507-9CrossRefPubMed

Bilezikian JP, Cusano NE, Khan AA et al (2014) Primary hyperparathyroidism. Nat Rev Dis Prim 53:417–424.e5. https://doi.org/10.1016/j.jaac.2013.12.025CrossRef

Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Jin J, Monteiro R, Mino J, Swagel W, Mitchell JC (2013) The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surg (United States) 154:1232–1238. https://doi.org/10.1016/j.surg.2013.06.051CrossRef

Yu N, Donnan PT, Murphy MJ, Leese GP (2009) Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf) 71:485–493. https://doi.org/10.1111/j.1365-2265.2008.03520.xCrossRef

Yeh MW, Ituarte PHG, Zhou HC, Nishimoto S, Amy Liu IL, Harari A, Haigh PI, Adams AL (2013) Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 98:1122–1129. https://doi.org/10.1210/jc.2012-4022CrossRefPubMedPubMedCentral

Alore EA, Suliburk JW, Ramsey DJ, Massarweh NN, Balentine CJ, Singh H, Awad SS, Makris KI (2019) Diagnosis and management of primary hyperparathyroidism across the Veterans Affairs health care system. JAMA Intern Med 179:1220–1227. https://doi.org/10.1001/jamainternmed.2019.1747CrossRefPubMedPubMedCentral

Seib CD, Meng T, Suh I, Cisco RM, Lin DT, Morris AM, Trickey AW, Kebebew E (2020) Undertreatment of primary hyperparathyroidism in a privately insured US population: decreasing utilization of parathyroidectomy despite expanding surgical guidelines. Surgery. 169:87–93. https://doi.org/10.1016/j.surg.2020.04.066CrossRefPubMed

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700CrossRefPubMedPubMedCentral

Kochersberger G, Buckley NJ, Leight GS, Martinez S, Studenski S, Vogler J, Lyles KW (1987) What is the clinical significance of bone loss in primary hyperparathyroidism? Arch Intern Med 147:1951–1953CrossRef

10.

Wilson RJ (1988) Mild asymptomatic primary hyperparathyroidism is not a risk factor for vertebral fractures. Ann Intern Med 109:959–962. https://doi.org/10.7326/0003-4819-109-12-959CrossRefPubMed

11.

Larsson K, Lindh E, Lind L, Persson I, Ljunghall S (1989) Increased fracture risk in hypercalcemia: bone mineral content measured in hyperparathyroidism. Acta Orthop 60:268–270. https://doi.org/10.3109/17453678909149275CrossRef

12.

Kenny AM, MacGillivray DC, Pilbeam CC et al (1995) Fracture incidence in postmenopausal women with primary hyperparathyroidism. Surgery 118:109–114CrossRef

13.

De Geronimo S, Romagnoli E, Diacinti D et al (2006) The risk of fractures in postmenopausal women with primary hyperparathyroidism. Eur J Endocrinol 155:415–420. https://doi.org/10.1530/eje.1.02225CrossRefPubMed

14.

Vignali E, Viccica G, Diacinti D et al (2009) Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 94:2306–2312. https://doi.org/10.1210/jc.2008-2006CrossRefPubMedPubMedCentral

15.

Kaji H, Yamauchi M, Chihara K, Sugimoto T (2005) The threshold of bone mineral density for vertebral fractures in female patients with primary hyperparathyroidism. Eur J Endocrinol 153:373–378. https://doi.org/10.1530/eje.1.01985CrossRefPubMed

16.

Eller-Vainicher C, Filopanti M, Palmieri S, Ulivieri FM, Morelli V, Zhukouskaya VV, Cairoli E, Pino R, Naccarato A, Verga U, Scillitani A, Beck-Peccoz P, Chiodini I (2013) Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol 169:155–162. https://doi.org/10.1530/EJE-13-0305CrossRefPubMed

17.

Larsson K, LJUNGHALL S, KRUSEMO UB et al (1993) The risk of hip fractures in patients with primary hyperparathyroidism: a population-based cohort study with a follow-up of 19 years. J Intern Med 234:585–593. https://doi.org/10.1111/j.1365-2796.1993.tb01017.xCrossRefPubMed

18.

Khosla S, Melton LJ, Wermers RA et al (1999) Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res 14:1700–1707. https://doi.org/10.1359/jbmr.1999.14.10.1700CrossRefPubMed

19.

Vestergaard P, Mollerup CL, Frøkjaer VG et al (2000) Cohort study of fracture risk before and after surgery of primary hyperparathyroidism. BMJ Clin Res ed 163:4875–4878

20.

Yu N, Donnan PT, Leese GP (2011) A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf) 75:169–176. https://doi.org/10.1111/j.1365-2265.2010.03958.xCrossRef

21.

Lewiecki EM, Miller PD (2013) Skeletal effects of primary hyperparathyroidism: bone mineral density and fracture risk. J Clin Densitom 16:28–32. https://doi.org/10.1016/j.jocd.2012.11.013CrossRefPubMed

22.

Silverberg SJ, Shane E, De La Cruz L et al (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 4:283–291CrossRef

23.

Hansen S, Jensen JEB, Rasmussen L et al (2010) Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: a case-control study using HR-pQCT. J Bone Miner Res 25:1941–1947. https://doi.org/10.1002/jbmr.98CrossRefPubMed

24.

Wang W, Nie M, Jiang Y, Li M, Meng X, Xing X, Wang O, Xia W (2020) Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism. Osteoporos Int 31:165–173. https://doi.org/10.1007/s00198-019-05186-1CrossRefPubMed

25.

Cusano NE, Rubin MR, Silva BC, Tay YKD, Williams JM, Agarwal S, Omeragic B, Guo XE, Bilezikian JP (2018) Skeletal microstructure and estimated bone strength improve following parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab 103:196–205. https://doi.org/10.1210/jc.2017-01932CrossRefPubMed

26.

Hansen S, Hauge EM, Rasmussen L, Jensen JEB, Brixen K (2012) Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: a one-year prospective controlled study using high-resolution peripheral quantitative computed tomography. J Bone Miner Res 27:1150–1158. https://doi.org/10.1002/jbmr.1540CrossRefPubMed

27.

Silva BC, Boutroy S, Zhang C, McMahon DJ, Zhou B, Wang J, Udesky J, Cremers S, Sarquis M, Guo XDE, Hans D, Bilezikian JP (2013) Trabecular bone score (TBS)-a novel method to evaluate bone microarchitectural texture in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 98:1963–1970. https://doi.org/10.1210/jc.2012-4255CrossRefPubMedPubMedCentral

28.

Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99:3561–3569. https://doi.org/10.1210/jc.2014-1413CrossRefPubMedPubMedCentral

29.

Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, Varhaug JE, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J, SIPH Study Group (2015) Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. J Clin Endocrinol Metab 100:1359–1367. https://doi.org/10.1210/jc.2014-3441CrossRefPubMed

30.

Ejlsmark-Svensson H, Bislev LS, Lajlev S, Harsløf T, Rolighed L, Sikjaer T, Rejnmark L (2018) Prevalence and risk of vertebral fractures in primary hyperparathyroidism: a nested case-control study. J Bone Miner Res 33:1657–1664. https://doi.org/10.1002/jbmr.3461CrossRefPubMed

31.

Bilezikian JP (2018) Primary hyperparathyroidism. J Clin Endocrinol Metab 103:3993–4004CrossRef

32.

Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89:5415–5422. https://doi.org/10.1210/jc.2004-0028CrossRefPubMed

33.

Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92:3114–3121. https://doi.org/10.1210/jc.2007-0219CrossRefPubMed

Titel: Risk of fractures in primary hyperparathyroidism: a systematic review and meta-analysis
verfasst von: H. Ejlsmark-Svensson
L. Rolighed
T. Harsløf
L. Rejnmark
Publikationsdatum: 01.02.2021
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 6/2021
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-021-05822-9

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2021

Hospital admissions of patients with osteogenesis imperfecta in the English NHS

The association between overweight/obesity and vertebral fractures in older adults: a meta-analysis of observational studies

Short time horizons for fracture prediction tools: time for a rethink

Increasing fasting glucose and fasting insulin associated with elevated bone mineral density—evidence from cross-sectional and MR studies

The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study