Endocrine Abstracts

Aims and Methods

Bone density (BMD) measurement is essential to assess the skeletal impact of primary hyperparathyroidism (PHPT). Coexistent osteoporosis is one of the criteria to consider parathyroidectomy in PHPT. PHPT is associated with predominant bone loss at the wrist. Assessment of BMD at this site is important to identify all patients with osteoporosis. Repeat BMDmeasurements are imperative to assess progression of disease, response to treatment and to modify therapy. We analyzed frequency of skeletal x-rays and DEXA utilization at baseline and on follow-up in PHPT patients attending medical clinics over an 8-year period (1996-2003). DEXA results, Radiology reports and demographic data were obtained electronically.

Results:

91 patients (14males) with mean age68years (range:24-86),and a primary or secondary diagnosis of PHPT were identified via the hospital computer system.

BMD was assessed during the 8-year period in 12(13%) PHPT patients (2males). Mean age of patients who had DEXA assessment was 69.3years (range: 49-89yrs) as opposed to 68.1years in those who did not. 3 patients had a repeat DEXA performed. Wrist density was reported in none of the patients. A spine, hip or limb x-ray was assessed in 43(47%) patients. An abnormal x-ray suggesting osteopenia, osteoporosis or fractures were documented in 19patients, of whom 3 underwent a DEXAscan. Similar number of patients (13%) underwent DEXA scanning in both <65 (n=31) and >/=65years (n=60) age groups.

Radiological investigations to identify the skeletal complications of primary hyperparathyroidism remain underutilised. No age bias was identified in assessment for osteoporosis. Frailty, poor mobility, and institutional residence in this characteristically elderly population might have contributed to clinical complacency resulting in low levels of BMD assessment. Awareness and attitudes of physicians regarding osteoporosis management in the elderly infirm who are at high risk for osteoporosis needs to be assessed. Peripheral DEXA scanning might be a feasible option to be considered.