PTH and bone material strength in hypoparathyroidism as measured by impact microindentation

Starr, J. R.; Tabacco, G.; Majeed, R.; Omeragic, B.; Bandeira, L.; Rubin, M. R.

Affiliations

¹Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, USA

²Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy

³Fleury Group, Sao Paulo, Brazil

Abstract and keywords

Summary: PTH levels might be associated with bone material strength as measured by impact microindentation. Resistance to microfracture is decreased in hypoparathyroidism and appears to be associated with more severe disease and to improve with PTH replacement.

Introduction: PTH is a key regulator of bone structure and remodeling. When PTH is absent in hypoparathyroidism (HypoPT), bone mass is increased and remodeling is decreased. In addition to bone structure and remodeling, bone material properties contribute to fracture resistance. Yet little is known about the relationship between PTH and bone material properties. Impact microindentation provides a clinical assessment of microfracture resistance, measured as the bone material strength index (BMSi).

Methods: Case-control cross-sectional study of PTH levels and in vivo BMSi measurement by impact microindentation at the anterior tibia in HypoPT patients (n = 17) and in controls matched for age, sex, and menopausal status (n = 17), with follow-up in a subgroup of HypoPT patients (n = 5) after recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] treatment.

Results: BMSi was positively associated with PTH levels in controls (r = 0.58, p = 0.02) and was 11% lower (p = 0.01) in HypoPT patients as compared with controls. In HypoPT, lower BMSi was associated with a trend toward greater supplemental calcium doses (p = 0.07). BMSi increased after rhPTH(1-84) treatment in the HypoPT patients who underwent repeat microindentation.

Conclusions: PTH levels might be associated with bone material strength, although other factors might be contributory. In HypoPT, resistance to microfracture is decreased and may be associated with greater supplemental calcium doses and might increase with PTH replacement. It remains to be determined whether changes in bone remodeling and microarchitecture contribute to the effects of PTH on microfracture resistance.

Keywords: Bone material strength; Hypoparathyroidism; Impact microindentation; rhPTH(1-84)

Links

DOI: 10.1007/s00198-019-05177-2

PubMed: 31720712

WoS: 000496218000007

History

Received: 2019-04-15

Accepted: 2019-09-23

Online: 2019-11-13

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2022	Fuleihan GE-H, Chakhtoura M, Cipriani C, Eastell R, Karonova T, Liu J-M, Minisola S, Mithal A, Moreira CA, Peacock M, Schini M, Silva B, Walker M, El Zein O, Marcocci C. Classical and nonclassical manifestations of primary hyperparathyroidism. J Bone Miner Res. November 2022;37(11):2330-2350.
2022	Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Gittoes NJ, Pasieka JL, Rejnmark L, Shoback DM, Potts JT, Guyatt GH, Mannstadt M. Evaluation and management of hypoparathyroidism summary statement and guidelines from the second international workshop. J Bone Miner Res. December 2022;37(12):2568-2585.
2022	Bjornsdottir S, Ing S, Mitchell DM, Sikjaer T, Underbjerg L, Hassan-Smith Z, Sfeir J, Gittoes NJ, Clarke L. BL. Epidemiology and financial burden of adult chronic hypoparathyroidism. J Bone Miner Res. December 2022;37(12):2602-2614.
2022	Yao L, Hui X, Li M, Li J, Ahmed MM, Lin C, Kandi M, Sreekanta A, Makhdami N, Tamilselvan D, Ali DS, Dandurand K, Yang K, Bilezikian JP, Brandi ML, Clarke BL, Mannstadt M, Rejnmark L, Khan AA, Guyatt G. Complications, symptoms, presurgical predictors in patients with chronic hypoparathyroidism: a systematic review. J Bone Miner Res. December 2022;37(12):2642-2653.