Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism.

Abstract

OBJECTIVE:

To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT).

DESIGN AND METHODS:

A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing.

RESULTS:

Fractured patients (n=100, 37.6%) had lower sCa (10.8±0.7 mg/dl) and Z-LS BMD (-1.0±1.44), higher age (61±10 years), and prevalence (51%) of ≥1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (n=166, 11.2±1.0 mg/dl, -0.57±0.97, 58±13 years, and 38% AS/SS, respectively, P<0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, P=0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, P=0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, P=0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, P=0.05). The presence of two out of three factors (age ≥58 years, sCa <10.8 and Z-LS BMD≤-1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P<0.0001).

CONCLUSIONS:

In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP.

• Authors: Cristina Eller-Vainicher, Claudia Battista, Vito Guarnieri, Silvana Muscarella, Serena Palmieri, Antonio Stefano Salcuni, Giuseppe Guglielmi, Sabrina Corbetta, Salvatore Minisola, Anna Spada, Geoffrey N Hendy, David E C Cole, Iacopo Chiodini, Alfredo Scillitani
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 171 Issue 3 Pg. 399-406 (Sep 2014) ISSN: 1479-683X [Electronic] England
• PMID: 24966175 (Publication Type: Journal Article)
• Copyright: © 2014 European Society of Endocrinology.

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Bone Density (physiology)
• Cross-Sectional Studies
• Female
• Humans
• Hyperparathyroidism, Primary (blood, diagnostic imaging, urine)
• Lumbar Vertebrae (diagnostic imaging, injuries)
• Male
• Middle Aged
• Radiography
• Risk Factors
• Spinal Fractures (blood, diagnostic imaging, urine)
• Young Adult