Hyperparathyroidism in proximal femur fractures biological and histomorphometric study in 21 patients over 75 years old

Abstract

Proximal femur fractures in elderly people are more and more frequent. Falls and senile bone disorders are the risk factors of this fracture. In order to understand the mechanisms of these bone disorders, we studied 21 consecutive patients with this fracture using bone histomorphometry. Measurements of serum intact parathormone (PTH), 25-(OH)-vitamin D, 1,25-(OH) 2-vitamin D and osteocalcin have been performed in these 21 patients, included in a larger series. We excluded patients with renal failure (serum creatinine greater than 140 mumols/l), cancer, or previous metabolic bone disease. There were 19 female and 2 male patients, ranging from 75 to 96 years, (mean 84.9). We found a low frequency of cortical (2/21) and trabecular (3/21) osteoporosis. There was no case of clearcut osteomalacia. Following histomorphometric bone study, two patients showed a typical pattern of hyperparathyroidism, and in a third one, this condition seemed very likely. In these three patients who were among the oldest, and who had high levels of serum PTH, chronic renal failure and primary hyperparathyroidism could be excluded. High bone remodeling was frequent in our patients, as reflected by the enhancement of eroded surfaces (13 cases) and of osteoid thickness (7 cases). Intact PTH level was elevated in our series compared to normal values in adults (in accordance to the PTH elevation in the case control study in a larger series). These findings suggest a major role of a secondary hyperparathyroidism in senile bone disorders favoring proximal femur fractures. This hyperparathyroidism is probably secondary to mild calcium and vitamin D deficiency. It may lead to architectural bone changes favoring this fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Calciotropic Hormones and Markers of Bone Remodeling in Age-Related (Type II) Femoral Neck Osteoporosis: Alterations Consistent with Secondary Hyperparathyroidism-Induced Bone Resorption

“…This level of osteocalcin in fractured patients agrees with a number of recent reports (10,12,20) and is consistent with a decreased bone formation, despite higher levels of PTH with a subsequent bone overremodeling. Bone histomorphometry of hip fracture patients has indeed provided evidence for decreased bone formation despite increased bone resorption (7,46,47), suggesting an imbalance (uncoupling) between formation and resorption in age-related osteoporosis. In contrast to our study, serum osteocalcin has been reported to be elevated (14,15,18) or normal (16,17,19) in hip fracture populations.…”

Vitamin D and fractures: a sistematic review

“…Per questo motivo i soggetti con ipovitaminosi D severa e di lunga durata possono andare incontro a condizioni di vera e propria disabilità. Sulla base di quanto sopra esposto, la relazione esistente tra deficit di vitamina D e rischio di frattura, in particolare di femore (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) appare giustificata sia dagli effetti deleteri sulla massa ossea, sia dall'aumento del rischio di caduta dovuta alla miopatia che l'insufficienza vitaminica D provoca. Diversi studi hanno valutato l'effetto della somministrazione di vitamina D sul rischio di frattura e ne hanno dimostrato l'effetto protettivo (29)(30)(31)(32)(33) confermato anche da metanalisi (34,35).…”

Les carences et insuffisances en vitamine D : une situation largement répandue, des mesures préventives à mettre en place

“…Il faut vraiment une quasi-absence de 25 (OH) vit D pour abaisser nettement le taux de 1,25 (OH) 2 vit D. Finalement, on aboutit à l'ensemble métabolique 25 (OH) vit D basse, calcémie et phosphorémie normales (ou à la limite inférieure de la norme), PTH élevée, 1,25 (OH) 2 vit D normale [5]. Cet ensemble métabolique favorise la perte osseuse avec hyperrésorption ostéoclastique et donc l'ostéoporose [9]. Cette situation est beaucoup plus courante que l'ostéomalacie et constitue un élément clé de l'ostéoporose du sujet âgé [10].…”