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Forearm DXA increases surgical criteria rate in asymptomatic hyperparathyroidism
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Adults with asymptomatic hyperparathyroidism who undergo forearm DXA scanning are more likely to meet surgical criteria vs. adults who do not undergo scanning at that site, recent study findings show.
“The diagnosis of [osteoporosis] in [asymptomatic hyperparathyroidism], besides leading to a more accurate clinical characterization of the disease, strongly impacts on the therapeutic decision, as it is included in surgical criteria,” Elena Castellano, MD, of the division of endocrinology, diabetes and metabolism at Santa Croce and Carle Hospital in Cuneo, Italy, and colleagues wrote. “Our study thus provides further substantial information: Forearm DXA assessments increased [asymptomatic hyperparathyroidism] patients fulfilling surgical indications by 5.2%. Therefore, the routine implementation of forearm DXA could change the therapeutic strategy in a non-negligible proportion of patients.”
Primary hyperparathyroidism (PHPT) often results in a reduction in bone mineral density at cortical sites, according to study background. Guidelines for the management of asymptomatic PHPT recommend a BMD evaluation at the lumbar spine, hip and forearm. Surgery is recommended for patients with a T-score of –2.5 or less at any of these sites; however, BMD evaluation at the forearm is not routinely performed.
Castellano and colleagues analyzed a prospective database of 116 patients with asymptomatic PHPT who underwent DXA scans at the lumbar spine, hip and forearm.
According to DXA results, 74 patients (64%) had osteoporosis; 47 patients (63.5%) had osteoporosis at the forearm. Of these, 13 had a T-score lower than –2.5 at the forearm only and were identified as group A (17.6% of osteoporotic patients and 27.7% of those with forearm osteoporosis); the remaining patients were identified as group B.
Researchers found that group A patients were older (71 ± 7.7 vs. 62.7 ± 11.8 years), whereas between-group differences in parathyroid hormone levels, 25-hydroxyvitamin D levels and BMD values at other sites were not statistically significant. Six of the 13 group A patients fulfilled the criteria for surgery based on forearm BMD alone, according to researchers.
“As no other specific predictor of forearm damage is currently available, our results support and strengthen the recommendation of the current guidelines to systematically perform DXA at three sites in all PHPT patients,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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