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Vertebral fractures common in idiopathic hypoparathyroidism
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Patients with idiopathic hypoparathyroidism have an increased risk for vertebral fractures despite increased bone mineral density, with the most pronounced risk among postmenopausal women and those on anticonvulsant therapy, according to a recent study from India.
Ravinder Goswami, MD, DM, of the department of endocrinology and metabolism at All India Institute of Medical Sciences in New Delhi, and colleagues evaluated 104 adults (mean age, 37.2 years) with idiopathic hypoparathyroidism and 64 healthy controls (mean age, 37.5 years) to determine the prevalence of vertebral fractures and related factors among people with idiopathic hypoparathyroidism and change in BMD through long-term follow-up.
Quantitative vertebral morphometry of thoracic and lumbar spine was used to assess vertebral fractures. DXA at the lumbar spine, hip and forearm was used to assess BMD, and a subset of 27 patients after 10 years of follow-up was used to evaluate change in BMD.
Compared with controls, the idiopathic hypoparathyroidism group had 21.4% higher mean BMD at the lumbar spine and 8.6% higher mean BMD at the hip (P < .001 for both).
The idiopathic hypoparathyroidism group had a higher prevalence of vertebral fractures (18.3%) compared with controls (4.7%; OR = 4.54; 95% CI, 1.28-16.04).
Compared with the idiopathic hypoparathyroidism group without vertebral fractures, the idiopathic group with vertebral fractures was more likely to have a history of seizures (P = .08) and a higher use of anticonvulsants (P = .09).
Through the 10-year follow-up, mean BMD significantly changed in all three regions.
“A significant proportion of patients with [idiopathic hypoparathyroidism] (18.3%) have vertebral fractures despite increased BMD at lumbar spine,” the researchers wrote. “The increased BMD in [idiopathic hypoparathyroidism] correlates with subnormal serum [parathyroid hormone] and hyperphosphatemia during long-term follow-up. Prolonged use of anticonvulsants and menopause are significant associates of [vertebral fractures]. Most vertebral fractures were clinically silent and were detected during this study.”
Spine deformities and impaired quality of life may occur in patients with idiopathic hypoparathyroidism due to the high prevalence of vertebral fractures, according to the researchers.
“Patients with [idiopathic hypoparathyroidism] should therefore be regularly screened for the presence of [vertebral fractures] despite increased BMD, especially in postmenopausal women and those on anticonvulsant therapy for hypocalcemic seizures, and regular spinal strengthening exercises should be advised to them,” the researchers wrote. “Efforts should be made to maintain a good calcemic control for withdrawal of anticonvulsants as early as possible.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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