Endocrine Abstracts

Introduction: Reduction in bone mineral density (BMD) is a common feature in primary hyperparathyroidism (PHPT), involving mostly cortical site. In the management of asymptomatic PHPT (aPHPT), guidelines indicate measuring BMD at lumbar spine, hip and forearm and surgery is recommended for patients with a T-score of −2.5 or less at one of these sites. However, BMD at forearm is not always performed.

Aim: Our aim was to evaluate the impact of measuring forearm BMD in the clinical and therapeutical management of aPHPT.

Subjects and methods: We retrospectively reviewed a prospective database of 116 patients with aPHPT at our institution between 1998 and 2013. The study cohort was identified by examining those patients who at the time of diagnosis had a dual X-ray absorptiometry (DXA) scan at all three sites. In all patients we measured PTH, total serum and ionized calcium, urinary calcium excretion, vitamin D and creatinine levels.

Results: Out of 116 patients with aPHPT we identified 13 (group A, 11.2%) who had a T score lower than −2.5 at forearm only, of which 6 (5.2%) possessed the criteria for surgery identified on the basis of forearm BMD only. Group B were the remaining 103 patients. Group A was older than group B (71±7.6 vs 62.7±11.8 years, P<0.016) while no significant difference was found in the biochemical measurements or in the BMD values at either of the other sites.

Conclusions: In our series of aPHPT, in 11.2% of patients, DXA on three sites revealed osteoporosis at forearm, but not at other sites. Among these patients, half were identified for surgery based on BMD at forearm. Except for age, these patients did not show any clinical, biochemical or BMD difference from the remaining patients. Preoperative forearm DXA increases the number of patients who meet the criteria for surgery based on BMD alone.