Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

Cristina Eller-Vainicher, Marcello Filopanti, Serena Palmieri, Fabio Massimo Ulivieri, Valentina Morelli, Volha V. Zhukouskaya, Elisa Cairoli, Rosa Pino, Antonella Naccarato, Uberta Verga, Alfredo Scillitani, Paolo Beck-Peccoz, Iacopo Chiodini

Research output: Contribution to journalArticle

Abstract

Objective: In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. Design:We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. Results: PHPT patients had lower TBS (K2.39±1.8) and higher VFx prevalence (43.5%) than controls (K0.98±1.07 and 8.2% respectively, both P!0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, PZ0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (C47±44.8,C29.2 ±34.1,C49.4G48.7 and C30.2±39.3% respectively, all P!0.0001). Among patients treated conservatively, TBS decreased significantly in those (nZ3) with incident VFx (K1.3±0.3) compared with those without (K0.01±0.9, PZ0.048), while BMD changes were not statistically different (LS 0.3G1.2 vs K0.8G0.9 respectively, PZ0.19; TH 0.4G0.8 vs K0.8±1.4 respectively, PZ0.13 and FN 0.4±0.9 vs K0.8±1.4 respectively, PZ0.14). Conclusions: In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalEuropean Journal of Endocrinology
Volume169
Issue number2
DOIs
Publication statusPublished - Aug 2013

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Primary Hyperparathyroidism
Bone Density
Bone and Bones
Femur Neck
Spine
Pelvic Bones
Photon Absorptiometry
Hip
Cancellous Bone
Thigh
Odds Ratio
Sensitivity and Specificity

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. / Eller-Vainicher, Cristina; Filopanti, Marcello; Palmieri, Serena; Ulivieri, Fabio Massimo; Morelli, Valentina; Zhukouskaya, Volha V.; Cairoli, Elisa; Pino, Rosa; Naccarato, Antonella; Verga, Uberta; Scillitani, Alfredo; Beck-Peccoz, Paolo; Chiodini, Iacopo.

In: European Journal of Endocrinology, Vol. 169, No. 2, 08.2013, p. 155-162.

Research output: Contribution to journalArticle

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title = "Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism",
abstract = "Objective: In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. Design:We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. Results: PHPT patients had lower TBS (K2.39±1.8) and higher VFx prevalence (43.5{\%}) than controls (K0.98±1.07 and 8.2{\%} respectively, both P!0.0001). TBS was associated with VFx (odds ratio 1.4, 95{\%} CI 1.1-1.9, PZ0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75{\%}) and specificity (61.5{\%}) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75{\%}, 72 and 44.2{\%}, and 64 and 65{\%} respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (C47±44.8,C29.2 ±34.1,C49.4G48.7 and C30.2±39.3{\%} respectively, all P!0.0001). Among patients treated conservatively, TBS decreased significantly in those (nZ3) with incident VFx (K1.3±0.3) compared with those without (K0.01±0.9, PZ0.048), while BMD changes were not statistically different (LS 0.3G1.2 vs K0.8G0.9 respectively, PZ0.19; TH 0.4G0.8 vs K0.8±1.4 respectively, PZ0.13 and FN 0.4±0.9 vs K0.8±1.4 respectively, PZ0.14). Conclusions: In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.",
author = "Cristina Eller-Vainicher and Marcello Filopanti and Serena Palmieri and Ulivieri, {Fabio Massimo} and Valentina Morelli and Zhukouskaya, {Volha V.} and Elisa Cairoli and Rosa Pino and Antonella Naccarato and Uberta Verga and Alfredo Scillitani and Paolo Beck-Peccoz and Iacopo Chiodini",
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T1 - Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

AU - Eller-Vainicher, Cristina

AU - Filopanti, Marcello

AU - Palmieri, Serena

AU - Ulivieri, Fabio Massimo

AU - Morelli, Valentina

AU - Zhukouskaya, Volha V.

AU - Cairoli, Elisa

AU - Pino, Rosa

AU - Naccarato, Antonella

AU - Verga, Uberta

AU - Scillitani, Alfredo

AU - Beck-Peccoz, Paolo

AU - Chiodini, Iacopo

PY - 2013/8

Y1 - 2013/8

N2 - Objective: In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. Design:We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. Results: PHPT patients had lower TBS (K2.39±1.8) and higher VFx prevalence (43.5%) than controls (K0.98±1.07 and 8.2% respectively, both P!0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, PZ0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (C47±44.8,C29.2 ±34.1,C49.4G48.7 and C30.2±39.3% respectively, all P!0.0001). Among patients treated conservatively, TBS decreased significantly in those (nZ3) with incident VFx (K1.3±0.3) compared with those without (K0.01±0.9, PZ0.048), while BMD changes were not statistically different (LS 0.3G1.2 vs K0.8G0.9 respectively, PZ0.19; TH 0.4G0.8 vs K0.8±1.4 respectively, PZ0.13 and FN 0.4±0.9 vs K0.8±1.4 respectively, PZ0.14). Conclusions: In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

AB - Objective: In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. Design:We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. Results: PHPT patients had lower TBS (K2.39±1.8) and higher VFx prevalence (43.5%) than controls (K0.98±1.07 and 8.2% respectively, both P!0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, PZ0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (C47±44.8,C29.2 ±34.1,C49.4G48.7 and C30.2±39.3% respectively, all P!0.0001). Among patients treated conservatively, TBS decreased significantly in those (nZ3) with incident VFx (K1.3±0.3) compared with those without (K0.01±0.9, PZ0.048), while BMD changes were not statistically different (LS 0.3G1.2 vs K0.8G0.9 respectively, PZ0.19; TH 0.4G0.8 vs K0.8±1.4 respectively, PZ0.13 and FN 0.4±0.9 vs K0.8±1.4 respectively, PZ0.14). Conclusions: In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

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