This article is more than 5 years old. Information may no longer be current.
Fracture risk, severity higher in patients with primary aldosteronism
Click Here to Manage Email Alerts
Patients with primary aldosteronism are more likely to sustain a vertebral fracture compared with healthy age- and sex-matched controls, according to recent findings.
“Previous reports have shown that aldosterone excess induces urinary excretion of calcium, leading to bone mineral density loss and high levels of parathyroid hormone, and patients with [primary aldosteronism] are at higher risk of osteopenia and osteoporosis than patients with essential hypertension,” Masakazu Notsu, MD, PhD, of the department of internal medicine at Shimane University Faculty of Medicine, Japan, and colleagues wrote. “A recent study reported that [vertebral fractures] tended to become more prevalent in [primary aldosteronism] than in non-[primary aldosteronism]. However, whether patients with [primary aldosteronism] are at higher risk for fracture than healthy individuals remains unclear.”
Notsu and colleagues analyzed data from 56 patients diagnosed with primary aldosteronism between January 2006 and October 2014 (mean age, 59 years; 44.7% men) and 56 age- and sex-matched healthy controls who underwent health screenings for osteoporosis. Researchers measured HbA1c, serum albumin, creatinine, total cholesterol, LDL and HDL cholesterol, triglycerides, intact parathyroid hormone, urine type I collagen cross-linked N-telopeptide, urinary calcium-to-creatinine ratio and percent tubular reabsorption of phosphate. BMD was measured at the lumbar spine and femoral neck via DXA; lateral X-rays of the thoracic and lumbar spine were also taken.
The prevalence of vertebral fracture was higher in the primary aldosteronism group vs. controls (44.6% vs. 23.2%; P < .05). Patients with primary aldosteronism showed severe fracture more frequently vs. controls (23.2% vs. 3.6%; P < .01); 13 patients in the primary aldosteronism group had grade 2 or 3 vertebral fractures vs. two controls.
Patients with primary aldosteronism also showed higher systolic and diastolic blood pressure, higher HbA1c and triglycerides, higher urinary calcium-to-creatinine ratio and lower HDL cholesterol vs. controls (P < .05 for all).
In logistic regression analyses adjusted for age, sex and BMI, primary aldosteronism was associated with presence of vertebral fractures (OR = 3.13; 95% CI, 1.3-7.51).
Results persisted after adjustment for BP, HbA1c, triglycerides and HDL cholesterol, but not after adjustment for urinary calcium-to-creatinine ratio (P = .062), lumbar BMD (P = .173) and femoral neck BMD (P = .103).
“Primary aldosteronism is a risk factor for prevalent vertebral fracture,” Notsu told Endocrine Today. “We need to recognize vertebral fractures as one of comorbidities of primary aldosteronism, as they are an important problem affecting mortality as well as quality of life. A longitudinal study is necessary to clarify the causal direction.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts