Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism

被引:25
作者
Eller-Vainicher, Cristina [1 ]
Battista, Claudia [2 ]
Guarnieri, Vito [2 ]
Muscarella, Silvana [2 ,3 ]
Palmieri, Serena [1 ]
Salcuni, Antonio Stefano [2 ]
Guglielmi, Giuseppe [4 ]
Corbetta, Sabrina [5 ]
Minisola, Salvatore [6 ]
Spada, Anna [1 ]
Hendy, Geoffrey N. [7 ,8 ,9 ]
Cole, David E. C. [10 ,11 ]
Chiodini, Iacopo [1 ]
Scillitani, Alfredo [2 ]
机构
[1] Univ Milan, Unit Endocrinol & Metab Dis, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Clin Sci & Community Hlth, I-20122 Milan, Italy
[2] Casa Sollievo Sofferenza, Unit Endocrinol, IRCCS, Foggia, Italy
[3] Fatebenefratelli & Oftalm Hosp, Radiol Unit, Milan, Italy
[4] Casa Sollievo Sofferenza, IRCCS, Radiol Unit, Foggia, Italy
[5] Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Unit Endocrinol & Diabetol, Milan, Italy
[6] Univ Roma La Sapienza, Dept Internal Med & Med Disciplines, I-00185 Rome, Italy
[7] McGill Univ, Dept Med, Montreal, PQ, Canada
[8] McGill Univ, Dept Physiol, Montreal, PQ, Canada
[9] McGill Univ, Dept Human Genet, Montreal, PQ, Canada
[10] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
[11] Univ Toronto, Dept Med & Genet, Toronto, ON, Canada
关键词
CALCIUM-SENSING RECEPTOR; FAMILIAL HYPOCALCIURIC HYPERCALCEMIA; TRABECULAR BONE SCORE; POSTMENOPAUSAL WOMEN; A986S POLYMORPHISM; MINERAL DENSITY; SERUM-CALCIUM; MUTATIONS; EXCRETION; COHORT;
D O I
10.1530/EJE-14-0343
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT). Design and methods: A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing. Results: Fractured patients (n=100, 37.6%) had lower sCa (10.8 +/- 0.7 mg/dl) and Z-LS BMD (-1.0 +/- 1.44), higher age (61 +/- 10 years), and prevalence (51%) of >= 1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (n=166, 11.2 +/- 1.0 mg/dl, -0.57 +/- 0.97, 58 +/- 13 years, and 38% AS/SS, respectively, P < 0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, P=0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, P=0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, P=0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, P=0.05). The presence of two out of three factors (age >= 58 years, sCa < 10.8 and Z-LS BMD% -1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P < 0.0001). Conclusions: In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP.
引用
收藏
页码:399 / 406
页数:8
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