Bone Mineral Density Screening Importance in Men with Sporadic Primary Hyperparathyroidism

Presentation Number: FRI 343
Date of Presentation: April 1st, 2016

Danica Maria Vodopivec*, Angelica Maria Silva, Kelly Schwarz, Ioannis Christakis, Ashley Stewart, Mimi I-Nan Hu and Nancy D Perrier
The University of Texas MD Anderson Cancer Center, Houston, TX

Abstract

Introduction: Sporadic primary hyperparathyroidism (sPHPT) affects up to 1% of the adult population, being more commonly detected in women, especially post-menopausal (post-MP). Surgery for sPHPT is associated with an increase in post-operative BMD, but there is no published literature on gender differences regarding BMD recovery. We aimed to investigate differences in BMD changes after PTX between men and women (pre-MP and post-MP) with sPHPT.

Methodology: Retrospective study of all adult patients who underwent PTX in our Institution (1990-2013). Patients were included if they had both pre- and post-operative DXA scans performed in our institution (biggest limitation for recruitment since most of our patients were referred with their initial DXA scan done at an outside institution), no recurrent or persistent disease post operatively, and did not receive any medical treatment interfering with bone or calcium metabolism.

The percentage change in BMD (gr/cm2) and T-scores were analyzed at baseline (pre-operative) and 12±6 months after surgery in the lumbar spine (LS), femoral neck (FN), total hip (TH) and distal one-third of the radius (D 1/3 R). Values were then compared between men and women (pre-MP and post-MP). p value < 0.05 was considered statistically significant.

Results: 1,467 patients underwent PTX and of these 105 patients met inclusion criteria. There were 72 women (68.6%; 13 pre-MP, 58 post-MP and 1 patient with unknown menopausal status) and 33 men (31.4%). The average age at PTX for men and women was 58±2 and 62±1 years old, respectively (p= 0.1707). The average time period between PHPT diagnosis and PTX for men and women was 5±1 and 11±2 months (p= 0.1322), respectively. There was no significant change in the BMD of D 1/3 R between study groups, thus this anatomical site is no further mentioned in the study.

There was no difference in initial severity of bone disease between post-MP and men in all 3 sites, and pre-MP had higher initial T-score values than men in the FN (p=<0.0001) and TH (p=0.0036). Pre-MP also had higher pre-operative T-scores than post-MP in all 3 sites (LS: p=0.0082, FN: p=<0.0001, TH: p=0.0015).

One year post-PTX men had 1.6% greater increase in their LS BMD (gr/cm2) when compared to females (p=0.0352).   Post-MP recovered their BMD values (gr/cm2) less than men in all three sites, and this was found to be significant in the FN and TH where men had 2.3% (p=0.0443) and 0.2% (p=0.0443) greater increase, respectively.

Conclusion: The significant increase in the BMD values (gr/cm2) of men after PTX should be reiterated as a potential surgical benefit to cure in this gender. Unfortunately, because sPHPT is more common in women, there is an epidemiologic tendency to underdiagnose sPHPT in men and to underutilize BMD in this gender because they are not considered as having clinically significant bone loss.

 

Nothing to Disclose: DMV, AMS, KS, IC, AS, MINH, NDP