Patients with History of Fractures Have Profound Abnormalities in Bone Metabolism and Thyroid Function

Presentation Number: SUN 315
Date of Presentation: April 2nd, 2017

Charilaos Chourpiliadis*1, Georgia Antoniou2, Stelios Kasikis3, Dimitra Bantouna4, Juan Carlos Jaume5 and Rodis D Paparodis6
1University of Patras Medical School, Patras, Greece, 2Karamandaneion Children's Hospital, Patras, Greece, 3University of Patras Medical School, 4University of Patras Hospital, Patras, Greece, 5University of Toledo, College of Medicine and Life Sciences, Toledo, OH, 6Private Practice, Patras, Greece


Background: In the past, fractures were believed to occur because of high-energy trauma. Recent studies opposed this theory, suggesting a potential link of fractures to preexisting abnormalities in bone metabolism. Our clinical observations favor the later hypothesis. Therefore, we designed the present study to address this controversy.

Methods: We prospectively enrolled adult (>18 years old) subjects of both genders, with a history of fractures (anytime during their lifetime), at our Endocrinology Practice in Patras, Greece, between 2014-2016. We performed bone mineral density (BMD) measurement with a DEXA scan and a thyroid ultrasound with assessment of gland vascularity with Doppler imaging. We measured serum calcium, albumin, phosphate, 25-D, PTH, 1,25-D, BUN, creatinine, ALP, TSH, total and free T3 and T4, Thyroid Peroxidase and Thyroglobulin antibodies. We collected urine over 24 hours for creatinine, calcium, phosphate, oxalate, urate and citrate when lithiasis was present. When clinically indicated, a Tc-99m thyroid scan was performed. We split our subjects’ BMD, based on the lowest T- or Z-score in “Normal” (>-1.0), “low bone mass” (LBM) (<-1.0, >-2.5) and “Osteoporosis” (OST) (<-2.4). Ratios were compared with χ2 test, while continuous variables were compared with one-way ANOVA.

Results: We screened 2624 and identified 311 subjects with history of fractures; 76.3% had abnormal BMD; 26.3% had OST and 50.0% had LBM. The mean “lowest T/Z score” was -1.7±1.2. 25-D deficiency (<30ng/ml) was present in 80.5% of subjects; 40.0% had very low 25-D concentration (<20ng/ml); 42.3% had high-normal PTH concentration (>50pmol/L). Mean 25-D concentrations and vitamin D deficiency rates were similar in all BMD groups (p>0.05); PTH was higher in OST compared to normal (53.8±26.0 vs. 43.2±20.0, p=0.03), but similar among OST and LBM (p>0.05). 3.3% of subjects had primary hyperparathyroidism; 7.8% had nephrolithiasis and 1.6% had hypercalciuria. TSH concentration was out of reference range (0.45-4.12mIU/ml) in 26.8% of subjects. Low TSH (<0.45mIU/ml) was present in 9.2% and high TSH (>4.12mIU/ml) was present in 17.5% of the subjects. TPO-Abs were elevated (>60IU/ml) in 20.7% and Tg-Abs were elevated (>60IU/ml) in 15.0% of the subjects; 55.3% had increased vascularity and 49.3% had nodules on ultrasound. Tc-99m uptake was increased in 73/107, decreased in 8/107 subjects; 16/107 subjects had toxic adenomas. Type 2 Diabetes was not a risk factor for osteoporosis or LBM (p>0.05 for both).

Discussion: Patients with history of fractures at any age, have endocrine anomalies, including very high rates of low BMD and osteoporosis, vitamin D deficiency, high-normal PTH concentrations, functional and structural thyroid disease. This population might require endocrine evaluation upon fracture, to better evaluate and treat the hormonal abnormaliites present.


Nothing to Disclose: CC, GA, SK, DB, JCJ, RDP