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Primary Hyperparathyroidism: Prevalence and Associated Morbidity in Middle-Aged Women and Elderly Men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Primary hyperparathyroidism (PHPT) is a common endocrine disease, existing in both genders and in all age groups. Postmenopausal women are at particular risk of developing the disease and estrogen decline after menopause is suggested to affect the progress. Although PHPT is mild in its presentation with subtle or no subjective symptoms, it is associated with an increased risk of associated morbidity and also mortality i.e cardiovascular complications, psychiatric instability, concomitant metabolic abnormalities, obesity and decrease in bone mineral density. The current cure is surgical removal of the diseased gland/s, but other medical alternatives have been investigated. The disease is thoroughly explored in postmenopausal women but less is known about other populations groups.

Since progression of the disease generally is slow, the underlying disturbance of the calcium homeostasis can be suspected to have been established a long time prior to diagnose with potential to affect associated morbidity. The general aim of this thesis is to clarify the expression of PHPT in premenopausal women and in elderly men and to explore how frequent the disease in these populations occurs. The women and men were investigated through population-based studies.

Baseline data and prevalence of PHPT in premenopausal women age 40-50 years were studied (Paper I), the prevalence was 5.1% in this population and was associated with decreased bone mineral density and associated obesity. In a three years follow up of the female cohort, the effects of menopausal transition and associated morbidity was investigated (Paper II). The prevalence and expression of PHPT in men between 69 and 81 years and impact on bone mineral density, physical performance, fall and fracture prevalence was explored through data from Mr Os Sweden (Papers III and IV). In this population prevalence of PHPT was 0.73% and associated with lower bone mineral density and inferior physical performance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 678
Keyword [en]
Primary hyperparathyroidism, menopausal, bone mineral density, physical performance, parathyroid hormone
National Category
Medical and Health Sciences
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-152270ISBN: 978-91-554-8097-4OAI: oai:DiVA.org:uu-152270DiVA: diva2:413186
Public defence
2011-06-11, Grönwallssalen, Akademiska sjukhuset, ingång 70, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-20 Created: 2011-04-27 Last updated: 2011-07-01Bibliographically approved
List of papers
1. Disturbances of calcium homeostasis consistent with mild primary hyperparathyroidism in premenopausal women and associated morbidity
Open this publication in new window or tab >>Disturbances of calcium homeostasis consistent with mild primary hyperparathyroidism in premenopausal women and associated morbidity
2008 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, Vol. 93, no 1, 47-53 p.Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Primary hyperparathyroidism (PHPT) and associated morbidity are comprehensively assessed in elderly females; however, less is known of the disease in younger women. OBJECTIVES: Our objectives were to estimate the prevalence of mild disturbances in calcium homeostasis, which could be analogous with early PHPT, in a premenopausal population, and determine the potential presence of associated morbidity. DESIGN: Initial results from this longitudinal study are from 2002-2004. SETTING: We conducted a population-based screening of serum (s)-calcium in conjunction with routine mammography. PARTICIPANTS: Participants included premenopausal women, 40-50 yr of age (n = 1900). Cases fulfilling previously evaluated biochemical criteria for PHPT (n=214) were matched to controls (n = 214). MAIN OUTCOME MEASUREMENTS: All participants underwent investigation, including screening of parameters of calcium homeostasis, dual x-ray absorptiometry, and body mass index assessment, and filled out extensive health and quality of life (SF-36) questionnaires. Participants were divided into four groups depending on the relation between s-calcium/intact PTH. Statistical comparisons between cases and controls as well as among the four groups were performed to evaluate morbidity. RESULTS: The prevalence of assumed mild PHPT, i.e. inappropriate intact PTH value in relation to total s-calcium, was estimated to be 5.1% (n = 96). Women with mild disturbances in calcium homeostasis had statistically significant lower bone mineral density in the proximal femur and femoral neck, higher body mass index, and lower scores for vitality and general health in the analysis of SF-36. CONCLUSIONS: Mild disturbances in calcium homeostasis in premenopausal women were more prevalent than previously thought and were associated with obesity, lower bone mineral density, and decreased quality of life.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-14752 (URN)10.1210/jc.2007-0600 (DOI)000252359400011 ()18042652 (PubMedID)
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2011-07-01Bibliographically approved
2. Primary hyperparathyroidism and associated morbidity during menopausal transition: three years follow-up
Open this publication in new window or tab >>Primary hyperparathyroidism and associated morbidity during menopausal transition: three years follow-up
2011 (English)In: Acta Endocrinologica, ISSN 1841-0987, Vol. 7, no 2, 249-262 p.Article in journal (Refereed) Published
Abstract [en]

Context. Postmenopausal women are at risk of developing primary hyperparathyroidism (PHPT) and the underlying disturbance in calcium homeostasis is suspected to have been established for some time prior to diagnosis. Objectives. Pre-menopausal women with disturbance in calcium homeostasis suggesting PHPT have been evaluated during menopausal transition regarding associated morbidity. Design and subjects. Premenopausal women, 40 to 50 years of age, were screened with parameters of calcium homeostasis in conjunction with routine mammography during 2002-2003. Those who fulfilled preset criteria of mild PHPT (cases) (n=173) were matched to controls (n=193). The pre/perimenopausal women were investigated for the prevalence of PHPT in association with skeletal changes, morbidity and impact on quality of life (base-line data already published). They have now been re-evaluated regarding different health aspects after three years follow-up. Results. The cases still had lower bone mineral density (BMD) in total hip, femoral neck and distal third of radius than controls (p<0.05) after three years followup. Time of follow-up, menopausal status, and weight affected BMD independently. Conclusion. Middle-aged women with mild disturbances of calcium homeostasis suggesting early PHPT, had lower BMD in the hip and radius, but the decline in BMD was not accelerated during menopausal transition.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-152180 (URN)10.4183/aeb.2011.249 (DOI)
Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2011-10-13Bibliographically approved
3. Prevalence of Primary Hyperparathyroidism and Impact on Bone Mineral Density in Elderly Men: MrOs Sweden
Open this publication in new window or tab >>Prevalence of Primary Hyperparathyroidism and Impact on Bone Mineral Density in Elderly Men: MrOs Sweden
Show others...
2011 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 35, no 6, 1266-1272 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Age and sex are of importance in the development of primary hyperparathyroidism (PHPT), and the disease is most common in postmenopausal women. Skeletal complications are well known at an advanced stage of PHPT, although the impact on bone mineral density (BMD) is evident in patients with mild disease. This study examines the prevalence of PHPT in elderly men and its impact on BMD. METHODS: Calcium homeostasis and BMD, measured by dual X-ray absorptiometry, were evaluated in 3014 men ages 69 to 81 years in the MrOS-Sweden cohort. Individuals with a low glomerular filtration rate (<21 ml/min/1.73 m(2)) and vitamin D deficiency (<50 nmol/l) were excluded. Among the remaining subjects, PHPT was assumed in subjects with above-normal albumin-adjusted serum (s)-calcium and plasma intact parathyroid hormone (p-iPTH) levels (PHPT group). BMD was compared between the PHPT group and men without PHPT. Subjects with inappropriately elevated iPTH (IEP group), based on both s-calcium (2.34 mmol/l) and iPTH (4.24 pmol/l) levels being above the median level, were compared to the rest of the cohort. RESULTS: The prevalence of PHPT was estimated to be 0.73%. The mean BMD in the total hip and femoral neck was lower in the PHPT group than in the PHPT controls. Significantly lower BMD (p < 0.05) was seen in the IEP group (total hip and lumbar spine). CONCLUSIONS: Elderly men appear to have a lower prevalence of PHPT than women at the same age. The impact of disturbed calcium homeostasis on BMD was also evident in this population group.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-152177 (URN)10.1007/s00268-011-1062-2 (DOI)000290536000020 ()21445668 (PubMedID)
Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2011-07-01Bibliographically approved
4. Associations of primary hyperparathyroidism and physical performance, fall- and fracture risk in elderly men - Mr Os Sweden: PHPT-physical performance, falls and fractures in elderly men
Open this publication in new window or tab >>Associations of primary hyperparathyroidism and physical performance, fall- and fracture risk in elderly men - Mr Os Sweden: PHPT-physical performance, falls and fractures in elderly men
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Primary hyperparathyroidism (PHPT) is an endocrine disease associated with deterioration of the skeleton and neuromuscular dysfunction. This study has explored associations between PHPT, physical function and risk of falls and fractures in elderly men.

Method: Serum parameters of calcium homeostasis, physical testing of neuromuscular function (grip strength, time stands, 6 meters walking and 20 cm narrow walking tests), self reported falls during 12 months preceding the testing and self reported fractures were evaluated in 3014 men aged 69 to 81 years in the MrOS Sweden cohort. Subjects were diagnosed with PHPT (n=22) if both albumin adjusted s-calcium and plasma parathyroid hormone (p-iPTH) were above normal in absence of renal failure and vitamin-D insufficiency. To evaluate impact of minor calcium disturbance, suggesting normocalcemic HPT, the total cohort were divided into subjects with inappropriately elevated iPTH (IEP-group), based on above median value of both s-calcium (2.34mmol/L) and iPTH (4.24 pmol/L) ( n=387 minus the 22 with PHPT, in total 365) and  subjects with normal calcium homeostasis (controls, n=1848). Group comparisons were made between PHPT-group and controls and IEP-group and controls.

Results: The IEP-group performed inferior in all but one of the muscular functioning tests (all p <0.01, respectively) and the PHPT-group performed inferior in the time stand test (p<0.05). There were no significant group differences in fall or fracture prevalence.

Conclusion: Elderly men with calcium disturbance, suggesting normocalcemic PHPT, had inferior physical performance than men with normal calcium homeostasis but it was not associated with higher fall or fracture prevalence.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-152226 (URN)
Available from: 2011-04-27 Created: 2011-04-27 Last updated: 2011-07-01

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