S ubjects with osteoporosis to remain at high risk for fracture despite benefit of prior bisphosphonate treatment — a D anish case-control study

AbstractSummaryThe benefits of pharmaceutical treatment for osteoporosis may be limited for a number of patients, as they continue to experience fractures. Alternative treatments may be considered for subjects whom remain at high risk for future fractures.IntroductionPrevious studies have investigated the effects of good adherence to anti-osteoporosis medication. However, very few studies have described why some patients experience fractures and loss of BMD despite adherence to treatment. The aim of this study was to estimate the proportion of patients at high risk for fracture despite being compliant to bisphosphonate treatment and examine which factors influence why some osteoporotic patients remain at a high risk for fracture despite being compliant to bisphosphonate treatment.MethodsThis case-control study is based on Danish national health registry data. The subjects had to have either one BMD test or a fracture prior to inclusion. “High-risk” subjects (cases) were defined as BMD t-score
Source: Osteoporosis International - Category: Orthopaedics Source Type: research

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Authors: Aresta C, Passeri E, Corbetta S Abstract Current primary hyperparathyroidism (PHPT) clinical presentation is asymptomatic in more than 90% of patients, while symptoms concern osteoporosis and rarely kidney stones. Here, we retrospectively investigated the prevalence of PHPT patients presenting with hypercalcemic-related symptoms (HS-PHPT) as cognitive impairment, changes in sensorium, proximal muscle weakness, nausea and vomiting, constipation, and severe dehydration, in a single center equipped with an emergency department and described their clinical features and outcome in comparison with a series of as...
Source: International Journal of Endocrinology - Category: Endocrinology Tags: Int J Endocrinol Source Type: research
We describe a unique case of hyperphosphatemia associated with a very high bone turnover rate in a 51-year-old postmenopausal woman with undiagnosed anorexia nervosa (AN) who presented with a low-trauma hip fracture. In view of her severely malnourished state, she was not fit for surgery. She was treated according to a refeeding protocol that mandated bed rest. Contrary to expectation, she developed sustained hyperphosphatemia and borderline hypercalcemia. Bone remodelling markers, both resorption and formation, were markedly elevated. Parathyroid hormone (PTH) was low-normal at 1.7  pmol/L, C-terminal fibroblast grow...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
A 63-year-old woman with a history of hypertension, gastric bypass, and renal lithiasis was found to have hypercalcemia (ionized calcium level: 1.42 mmol/L) in a routine blood test. Complete laboratory workup showed a parathyroid hormone level of 141.6 pg/dL (reference range, 10 –77) with normal renal function. Bone densitometry revealed osteoporosis with a T-score in the middle radius of –3.2. The diagnosis was primary hyperparathyroidism with surgical criteria (renal lithiasis and osteoporosis).
Source: Surgery - Category: Surgery Authors: Source Type: research
ConclusionsPHPT affects geometry, volumetric density, and microstructure in both the cortical and trabecular bones in both male and female Chinese patients. MHPT patients were observed to have reduced aBMD as determined by DXA in the lumbar spine and hip in comparison with sporadic PHPT patients. However, HR-pQCT indices were not observed to differ.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
CONCLUSION: Parathyroidectomy provided more BMD gain in the lumbar spine and femoral neck in patients with symptomatic PHPT when compared to patients with asymptomatic PHPT 1-year after parathyroidectomy. PMID: 31655512 [PubMed - as supplied by publisher]
Source: Turkish Journal of Medical Sciences - Category: General Medicine Tags: Turk J Med Sci Source Type: research
AbstractFamilial hypocalciuric hypercalcemia (FHH) is a benign autosomal dominant condition characterized by lifelong asymptomatic hypercalcemia. FHH is typically caused by a heterozygous inactivating mutation of the calcium-sensing receptor (CaSR) and characterized by moderate hypercalcemia, inappropriately normal or elevated serum parathyroid hormone (PTH), and relative hypocalciuria (FeCa  2%. PTH levels were repeatedly below the mean of the reference range (on two separate assays) and sometimes even below the lower reference limit. Two siblings, one niece, and her son had hypercalcemia without nephrolithiasis. C...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
Primary hyperparathyroidism (PHPT) is a disorder where 1 or more parathyroid glands become overactive, resulting in overproduction of parathyroid hormones. The diagnosis of PHPT is often made in the primary care setting based on elevated serum calcium with inappropriately elevated parathyroid hormone levels. Classic signs and symptoms include kidney calculi, osteoporosis, peptic ulcers, and fatigue. After diagnosis is made, early referral to an experienced endocrine surgeon is necessary because surgery is the only definitive treatment for PHPT.
Source: The Journal for Nurse Practitioners - Category: Nursing Authors: Tags: Featured Article Source Type: research
, Muñoz-Torres M Abstract CONTEXT: primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy X-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed 3D-DXA software might overcome this issue. OBJECTIVE: to examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group. DESIGN: cross-sectional pilot study. SETTING: hospital. PATIENTS: 80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 healthy age- ...
Source: The Journal of Clinical Endocrinology and Metabolism - Category: Endocrinology Authors: Tags: J Clin Endocrinol Metab Source Type: research
AbstractPurposeScreening for vertebral fractures (VF) in primary hyperparathyroidism (PHPT) is recommended, but there are limited data regarding which patients are at greatest risk for VF. We evaluated risk factors for VF in PHPT.MethodsThis is a retrospective cross-sectional analysis of 117 participants with PHPT. We assessed Grades 2 and 3 VF by vertebral fracture assessment (VFA) and the association of VF with the trabecular bone score (TBS), other skeletal parameters and clinical risk factors. VFA was performed only in those who met National Osteoporosis Foundation criteria for VFA screening.ResultsT-scores were in the...
Source: Endocrine - Category: Endocrinology Source Type: research
ConclusionsWe found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
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