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Joint Bone Spine
Volume 79, n° 2
pages 170-175 (mars 2012)
Doi : 10.1016/j.jbspin.2011.04.005
accepted : 5 April 2011
Functional hypoparathyroidism in postmenopausal women with fragility fracture
 

Adamah Amouzougan a, Florence Chopin a, b, Silvy Laporte c, Laurence Vico b, Thierry Thomas a, , b
a Inserm U1059, Rheumatology Department, University Hospital of Saint-Étienne, 42055 Saint-Étienne cedex 2, France 
b LBTO-Inserm U1059, University Jean-Monnet, 42023 Saint-Étienne, France 
c URCIP, EA3065, University Jean-Monnet, 42023 Saint-Étienne, France 

Corresponding author. Tel.: +33 477 12 76 49; fax: +33 477 12 75 77.
Abstract
Introduction

Secondary hyperparathyroidism sometimes is lacking despite authentic vitamin D insufficiency (VDI) and the concept of functional hypoparathyroidism with a protective role on bone status has been proposed. Therefore, we tested the hypothesis that its prevalence was very low in a population of women with a peripheral fragility fracture.

Methods

We conducted our study in postmenopausal women, admitted for such a fracture in our Fracture Liaison Service. All had bone mineral density (BMD), biochemical assessment and a medical visit.

Results

Two hundred and thirty seven women (72.9±11.6-year-old) were included and 90.4% had VDI (25[OH]D30ng/mL). Yet, 87.9% of the latter had normal PTH levels less or equal to 64ng/L. In this population with VDI (n =214), we found no PTH plateau level related to 25(OH)D. Since a recent study reported an increase in the risk of fracture only when 25(OH)D was below 15ng/mL, we then used this value as a new threshold. We observed a significant difference in hip BMD between patients with 25(OH)D either less or equal to or greater than 15ng/mL. However, 81.2% of the formers were still with normal PTH with no difference in BMD whether PTH level was above or within normal range.

Conclusion

In a population of postmenopausal women with a fragility fracture, we found that 25(OH)D less or equal to 15ng/mL was associated with significantly lower hip BMD. Even using this low threshold, we found a high prevalence of functional hypoparathyroidism and it was not associated with any difference in hip or spine BMD. Overall, our results do not support the hypothesis of a protective effect of this biological profile.

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Keywords : Bone mineral density, Fragility fractures, Hypoparathyroidism, Postmenopausal osteoporosis, Vitamin D




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