Oya TOPALOĞLU, Bekir ÇAKIR, Beril Turan ERDOĞAN, Pervin DEMİR, Cevdet AYDIN, Reyhan ERSOY, Hüsniye BAŞER, Abbas Ali TAM

WHAT ARE THE PARAMETERS THAT PREDICT THE DEVELOPMENT OF NEPHROLITHIASIS AND OSTEOPOROSIS IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM?

Objectives: Primary hyperparathyroidism (PHPT) is associated with an increased risk of nephrolithiasis and osteoporosis, and predicting the development of these diseases will reduce PHP-related morbidities. Materials and Methods: A total of 311 patients with PHPT due to parathyroid adenoma were evaluated retrospectively. The patients were divided into groups, as patients with and without nephrolithiasis and those with and without osteoporosis. Demographic and biochemical variables that could predict the development of nephrolithiasis and osteoporosis in these groups were examined. Results: Nephrolithiasis was observed in 24.44% of 311 PHPT patients. Serum creatinine (Cr), serum calcium (Ca), adjusted Ca (adj Ca), albumin and 24-hour urinary phosphorus (24h uP) levels were higher, and serum P- value was significantly lower in patients with nephrolithiasis than those without nephrolithiasis. In the Receiver Operating Characteristic (ROC) analysis, serum Cr ≥0.66 mg/dl, adj Ca ≥10.72 mg/dl, serum P ≤2.71 mg/dl and 24h uP ≥635 mg/day cut-off values were found to have high sensitivity and low specificity values on the risk of developing nephrolithiasis. Of all patients, 43.09% had osteoporosis, and it was determined that only ≥50.50 years (sensitivity 81.34%, specificity 49.51%) and intact parathyroid hormone ≥ 201.50 pg/mL (sensitivity 75.14%, specificity 41.04%) values could predict osteoporosis (Area Under the ROC curve ranged from 0.57 to 0.67). Conclusion: While biochemical parameters are useful in predicting nephrolithiasis in patients with PHPT, the development of osteoporosis seems to be less related to biochemical parameters.

PDF

___

1. Walker MD, SilverbergSJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018;14(2):115–25.
2. Silverberg SJ, Clarke BL, Peacock M, et al. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3580–94.
3. De Geronimo S, Romagnoli E, Diacinti D, D’Erasmo E, Minisola S. The risk of fractures in postmenopausal women with primary hyperparathyroidism. Eur J Endocrinol. 2006;155(3):415–20.
4. Khosla S, Melton LJ III, Wermers RA, Crowson CS, O’Fallon Wm, Riggs B. Primary hyperparathyroidismand the risk of fracture: a population-based study. J Bone Miner Res. 1999;14(10):1700–7.
5. Liu M, Williams J, Kuo J, Lee JA, Silverberg SJ, Walker MD. Risk factors for vertebral fracture in primary hyperparathyroidism. Endocrine 2019;66(3):682–90.
6. Suh JM, Cronan JJ, Monchik JM. Primary hyperparathyroidism: Is there an increased prevalence of renal stone disease? Am J Roentgenol. 2008;191(3):908–11.
7. Cipriani C, Biamonte F, Costa AG, et al. Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J Clin Endocrinol Metab. 2015;100(4):1309–15.
8. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99(10):3561–9.
9. Berger AD, Wu W, Eisner BH, et al. Patients with primary hyperparathyroidism-why do some form stones? J Urol. 2009;181(5):2141–5.
10. Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. Wiley; 2013:177.
11. Rejnmark L, Vestergaard P, Mosekilde L. Nephrolithiasis and renal calcifications in primary hyperparathyroidism. J Clin Endocrinol Metab. 2011;96(8):2377–85.
12. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999;341(17):1249–55.
13. Reid LJ, Muthukrishnan B, Patel D, Seckl JR, Gibb FW. Predictors of nephrolithiasis, osteoporosis, and mortality in primary hyperparathyroidism. J Clin Endocrinol Metab. 2019;104(9):3692-3700.
14. Patron P, Gardin JP, Paillard M. Renal mass and reserve of vitamin D: determinants in primary hyperparathyroidism. Kidney Int. 1987;31(5):1174–80.
15. Saponaro F, Cetani F, Mazoni L, et al. Hypercalciuria: its value as a predictive risk factor for nephrolithiasis in asymptomatic primary hyperparathyroidism? J Endocrinol Invest. 2020;43(5):677–82.
16. Ejlsmark-Svensson H, Bislev LS, Rolighed L, et al. Predictors of renal function and calcifcations in primary hyperparathyroidism: a nested case-control study. J Clin Endocrinol Metab. 2018;103(9):3574–83
17. Tay YKD, Liu M, Bandeira L, et al. Occult urolithiasis in asymptomatic primary hyperparathyroidism. Endocr Res. 2018;43(2):106–15.
18. Curhan GC, Taylor EN.24-h uric acid excretion and the risk of kidney stones. Kidney Int. 2008; 73(4): 489– 96.
19. Lemos ALP, Andrea SRL, Pontes LLH, et al. High rate of occult urolithiasis in normocalcemic primary hyperparathyroidism. Kidney Blood Press Res. 2019;44(5):1189-95.
20. Silverberg SJ. Skeletal disease in primary hyperparathyroidism. J Bone Miner Res. 1989;4(3): 283–91.
21. Stein EM. Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women. J Bone Miner Res. 2013;28(5):1029–40.
22. Hansen S, Hauge EM, Rasmussen L, Jensen JE, Brixen K. Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: a one-year prospective controlled study using high resolution peripheral quantitative computed tomography. J. Bone Miner Res. 2012;27(5):1150–8.
23. Kaji H, Yamauchi M, Chihara K, Sugimoto T. The threshold of bone mineral density for vertebral fractures in female patients with primary hyperparathyroidism. Eur J Endocrinol. 2005;153(3):373–8.
24. Viccica G, Cetani F, Vignali E, Miccoli M, Marcocci C. Impact of vitamin D deficiency on the clinical and biochemical phenotype in women with sporadic primary hyperparathyroidism. Endocrine 2017;55(1):256–65.
25. Walker MD. Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation. J Clin Endocrinol Metab. 2015;100(9):3443–51.
26. Eller-Vainicher C, Filopanti M, Palmieri S, et al. Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol. 2013;169(2):155–62.
27. Romagnoli E, Cipriani C, Nofroni I, et al. “Trabecular Bone Score” (TBS): an indirect measure of bone microarchitecture in postmenopausal patients with primary hyperparathyroidism. Bone 2013;3(1):154– 9.