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Mild Asymptomatic Primary Hyperparathyroidism Is Not a Risk Factor for Vertebral Fractures

Robert J. Wilson, MD; D. Sudhaker Rao, MB, BS; Burton Ellis, MD; Michael Kleerekoper, MB, BS; and A. Michael Parfitt, MB, BCh
[+] Article, Author, and Disclosure Information

Requests for Reprints: D. Sudhaker Rao, MD, Division of Bone and Mineral Metabolism, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.

Current Author Addresses: Drs. Wilson, Rao, Kleerekoper, and Parfitt: Division of Bone and Mineral Metabolism, and Dr. Ellis, Department of Internal Medicine, and Division of Skeletal Radiology; Department of Diagnostic Radiology, Henry Ford Hospital, Detroit, MI 48202.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(12):959-962. doi:10.7326/0003-4819-109-12-959
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Study Objective: To determine the prevalence of vertebral fractures in patients with mild asymptomatic primary hyperparathyroidism and to ascertain whether this prevalence is increased in comparison with the rate in a retrospective control group previously studied at the same institution or with current estimates of the risk for vertebral fractures in subjects of similar age.

Design: Prospectively collected data were retrospectively analyzed and compared with data from a historical control group at the same institution and with published data.

Setting: The outpatient department of a bone and mineral metabolism clinic.

Patients: A consecutive series of patients with mild asymptomatic primary hyperparathyroidism diagnosed between 1 January 1976 and 31 December 1985. Criteria for inclusion in the study were the absence of symptoms due to hyperparathyroidism, no current kidney stone disease, no radiographic evidence of osteitis fibrosa, a serum calcium level of less than 3.00 mmol/L, a serum creatinine level of less than 133 µmol/L, and a forearm bone density value not more than 2.5 standard deviations below the age-, sex-, and race-adjusted normal value.

Interventions: A conservative nonintervention study.

Measurements and Main Results: The prevalence of vertebral fractures in 174 patients (mean age, 62 years) with mild asymptomatic primary hyperparathyroidism was 1.7%; in a subset of white women, the prevalence was 2.8%. These rates were not higher than those expected, by comparison with the rate in a retrospective control group or with the risk for vertebral fractures in subjects of similar age, and may even be lower.

Conclusions: The risk for vertebral fractures is not increased in patients with mild asymptomatic primary hyperparathyroidism and is not a reason to recommend surgical intervention in asymptomatic patients. The increased rates of vertebral fractures that occurred in other series are probably due to the use of inappropriate controls and the influence of referral or selection bias, the inclusion of patients with severer disease, and the effect of geographic differences in vitamin D nutrition on the expression of disease. Possible differences between lateral spine and lateral chest radiographs for determining vertebral body shape need further study.





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