Bone Analysis by the Trabecular Bone Score and 3D-DXA in Postmenopausal Women with Primary Hyperparathyroidism.

Abstract

OBJECTIVE\nA predominance of bone loss in cortical sites with relative preservation of the trabecular bone, even in postmenopausal women, has been described in primary hyperparathyroidism (PHPT). The aim of this study was to evaluate bone microarchitectural differences using dual-energy X-ray absorptiometry (DXA), Trabecular Bone Score (TBS) and DXA-based 3-D modeling (3D-DXA) in postmenopausal women diagnosed with PHPT (PM-PHPT) and postmenopausal healthy controls.\n\n\nMETHODS\nThis retrospective study included 44 PM-PHPT (9 of whom had fractures) and 48 healthy women matched by age, body mass index (BMI) and years since menopause treated at Hospital Universitario Fundación Jiménez Díaz between 2008 and 2017. Bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), total hip (TH) and 1/3 radius were assessed by DXA; and trabecular volumetric BMD (vBMD), cortical vBMD, integral vBMD, cortical thickness and cortical surface BMD at TH by 3D-DXA software and TBS at the LS.\n\n\nRESULTS\nMean adjusted BMD values at the LS, FN and TH, TBS at the LS, and TH 3D-DXA parameters (trabecular vBMD, integral vBMD, cortical thickness and cortical surface BMD) were significantly reduced in PM-PHPT compared to controls. However, differences in mean cortical vBMD were not statistically significant (p=0.078). There were no significant differences in mean BMD, TBS or 3D-DXA parameters between fractured and nonfractured patients. 25-hydroxy vitamin D level appear to be associated with TBS but not with DXA and 3D-DXA measurements.\n\n\nCONCLUSION\nPM-PHPT have significant involvement of the trabecular and cortical compartment of bone when studied by DXA, TBS and 3D-DXA.