ECE2020 Audio ePoster Presentations Bone and Calcium (121 abstracts)
DXA scanning in primary hyperparathyroidism: Should forearm DXA be performed routinely?
Hamide Piskinpasa 1 , Sema Ciftci Dogansen 1 , Duygu Metin 2 , Nuri Alper Sahbaz 3 , Husnu Aydın 3 , Ayse Esen 1 , Evin Bozkur 1 , Seda Turgut 1 , Naim Pamuk 1 , Ilkay Cakir 1 & Meral Mert 1
1Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Endocrinology and Metabolism; 2Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology; 3Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery
Introduction: Primary hyperparathyroidism (PHPT) is a disease associated with a decrease in bone mineral density (BMD), especially in cortical bones such as distal radius. Therefore, the BMD measurement of forearm is valuable in the detection of cortical bone loss by PHPT. However, forearm measurement is not routinely recommended for the diagnosis of osteoporosis in PHPT. In this study, we aimed to evaluate the importance and priority of forearm BMD measurement in PHPT.
Material and Methods: 286 (249 female/37 male) patients with PHPT and eGFR>60 ml/min, whose BMD was measured at lumbar spine, femur and forearm by dual-energy X-ray absorptiometry (DXA) wererecruited to the study. The patients were divided into two groups as group 1 (n = 139) with forearm osteoporosis and group 2 (n = 147) without forearm osteoporosis. Age, sex, creatinine, eGFR, alkaline phosphatase (ALP), corrected calcium, phosphorus, magnesium, parathormone, 25 OH vitamin D, 24-hour urine calcium levels were recorded and compared between the groups. Additionally, patients with osteoporosis at any site, forearm osteoporosis, and the other two regions were normal but only with forearm osteoporosis were evaluated as three groups. The effect of the isolated forearm osteoporosis on surgical criteria was evaluated in patients without other surgical indications.
Results: The mean age at diagnosis of PHPT was 55.9 ± 12.1 years. Our patients in group 1 were older than in group 2 (P = 0.001). 151 (53%) patients have osteoporosis at any site, 139 (49%) have forearm osteoporosis, and only 76 (27%) patients have osteoporosis at forearm while the other two sites were normal. ALP, corrected calcium and parathormone levels in group 1 were significantly higher than patients in group 2 (P = 0.005, P = 0.005, P < 0.001, respectively). The groups were similar in terms of other variables. Only the isolated forearm osteoporosis was determined as the surgical indication in 22 patients who did not meet any other surgical criteria. In the light of these findings, additional operation indication was established by evaluating the forearm BMD in 7% (n = 22/286) patients of the study group.
Conclusion: Although forearm BMD measurement is not routinely recommended in patients with PHPT, only spine and femur evaluation may not be adequate since cortical bone loss is more expected in this disease course. In our study, the frequency of diagnosis of osteoporosis and operation indication increased with BMD measurements, including forearm site. Therefore we suggest forearm BMD measurement to be performed routinely in PHPT.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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