Abstract
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.
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This study received funding from NIH R01 DK069350 and K24-DK074457.
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The study was approved by the Columbia University Medical Center Institutional Review Board and informed written consent was obtained from all participants.
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JRS, GT, RM, BO, and LB have nothing to declare. MRR receives grant support from Shire/Takeda Pharmaceuticals and Amgen and has received speaker fees from Shire Pharmaceuticals and Amgen.
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Starr, J., Tabacco, G., Majeed, R. et al. PTH and bone material strength in hypoparathyroidism as measured by impact microindentation. Osteoporos Int 31, 327–333 (2020). https://doi.org/10.1007/s00198-019-05177-2
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DOI: https://doi.org/10.1007/s00198-019-05177-2