ECE2024 Poster Presentations Calcium and Bone (36 abstracts)
The clinical presentation of primary hyperparathyroidism: effects of obesity and vitamin D deficiency
Vit Zikan 1,2 , Jan Hrdlicka 3 , Judita Klímová 4 , Václav Hána Jr 1 , Monika Wagnerova 5 , Petr Libánský 6 , Dana Michalska 1 , Renata Vlasakova 1 & Ivan Raska Jr 1
1General University Hospital in Prague, Department of Internal Medicine 3, Prague, Czech Republic; 2General University Hospital, Internal Medicine 3, Prague, Czech Republic; 3General University Hospital in Prague, Department of Radiology, Prague, Czech Republic; 4Military University Hospital in Prague, Department of Internal Medicine, Prague, Czech Republic; 5General University Hospital in Prague, Department of Radiology and Institute of Nuclear Medicine, Prague, Czech Republic; 6Motol University Hospital in Prague, Department of Surgery III, Prague, Czech Republic
Our understanding of modifiable risk factors for developing primary hyperparathyroidism (PHPT) may support interventions to prevent the development of the disease or reduce its severity and deepen our insights into its pathogenesis. Obesity has been associated with elevated serum parathyroid hormone (PTH) in the general population and may also alter the clinical presentation in patients with PHPT.
Objectives: The objectives of the study were to compare the clinical, radiological and biochemical presentation of obese vs nonobese PHPT patients and to assess the impact of obesity and vitamin D deficiency on the presentation of PHPT.
Methods: Calcium metabolism and bone turnover markers (BTMs) S-CTX and PINP were analysed. Bone mineral density (BMD) and body composition was assessed by dual-energy X-ray absorptiometry (DXA). Clinical fractures were assessed from medical records.
Results: One hundred forty-four PHPT patients (79% postmenopausal women) were included in this analysis. Sixty-three percent of patients fulfilled the criteria for asymptomatic PHPT (84 patients with classic PHPT and 11 patients were normocalcemic, NHPT). Obesity was diagnosed in 64% of NHPT patients and in 44% of PHPT. The obese patients showed higher BMD in total and femoral neck and a lower rate of osteoporosis (41.8% vs 60.7%); however higher prevalence of clinical vertebral fractures was observed in obese women (9% vs 3.6%). Regarding the BTMs, it was found to be significantly lower values in women with obesity (P< 0.05); however, the comparison of those with severe deficient (<25 nmol/l; 18.8%) vs replete (≥75 nmol/l; 15%) 25OHD demonstrated more severe PHPT as reflected by significantly higher PTH, Ca and BTMs. Conclusions: In PHPT and NHPT patients, obesity is a protective factor for hip BMD; however, our findings of higher number of vertebral fractures in obese women suggest that BMD does not adequately assess the risk for vertebral fractures. Severe vitamin D deficiency may increase PTH and bone loss.
Keywords: primary hyperparathyroidism, obesity, osteoporosis, vitamin D deficiency
Volume 99
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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