Endocrine Abstracts

Background and objective

An increased risk of fractures in Primary Hyperparathyroidism (PHPT) has been reported in a number of relatively small studies. Performing a systematic literature search we identified available studies and calculated common estimates by pooling results from the individual studies in a meta-analysis.

Methods: Searching EMBASE and PubMed using both free text word search and Mesh terms we identified published studies reporting the risk of fractures in PHPT compared to a control group or compared to the expected fracture rates from the general population. We calculated odds ratio (OR) with 95% confidence interval (CI).

Results: A total of 804 studies were identified of which 13 studies and a total number of 5457 PHPT patients and 13633 controls were included. Overall, risk of any fracture was increased compared to controls (OR 2.01; 95% CI, 1.61–2.50; I² 46%, 5 studies). Analysis of fracture risk at specific sites showed an increased risk of fracture at the forearm (OR 2.36; 95% CI, 1.64–3.38; I² 0%, 4 studies) and spine (OR 3.50; 95% CI, 1.66–7.89; I² 87%, 10 studies). Risk estimate for hip fractures was also increased although non-significantly (OR 1.27; 95% CI, 0.97–1.66; I² 0%, 3 studies). Risk of vertebral fractures (VFx) was also increased if analyses were restricted to only studies with a healthy control group (OR 5.76; 95% CI, 3.86–8.60; I² 29%, 6 studies), studies including only patients with mild PHPT (OR 4.22; 95% CI, 2.20–8.12; I² 57%, 4 studies), or studies including only postmenopausal women (OR 8.07; 95% CI, 4.79–13.59; I² 0%, 3 studies).

Conclusions: Overall, PHPT is associated with an increased risk of fractures. Although number of studies are limited – it seems that the risk is increased across different skeletal sites including patients with mild PHPT. Of notice, relative risk of VFx seems to be extraordinarily high in postmenopausal women.