Increased bone fragility over time in women with chronic hypoparathyroidism: Real-world data from the HypoparaNet Italian Cohort

Francesca Giusti; Francesca Marini; Blandine Weiss; Michel Ovize; Salvatore Benvenga; Filomena Cetani; Annamaria Colao; Sabrina Corbetta; Uberti Ettore Degli; Maurizio Iacobone; Andrea Lenzi; Giovanna Mantovani; Rmggeri Rosaria Maddalena; Maria Luisa Brandi

doi:10.1530/endoabs.99.RC10.4

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Endocrine Abstracts (2024) 99 RC10.4 | DOI: 10.1530/endoabs.99.RC10.4

ECE2024 Rapid Communications Rapid Communications 10: Calcium and Bone | Part II (5 abstracts)

Increased bone fragility over time in women with chronic hypoparathyroidism: Real-world data from the HypoparaNet Italian Cohort

Francesca Giusti ¹ , Francesca Marini ² , Blandine Weiss ³ , Michel Ovize ³ , Salvatore Benvenga ⁴ , Filomena Cetani ⁵ , Annamaria Colao ⁶ , Sabrina Corbetta ^7,8 , Ettore Degli Uberti ⁹ , Maurizio Iacobone ¹⁰ , Andrea Lenzi ¹¹ , Giovanna Mantovani ¹² , Rosaria Maddalena Rmggeri ¹³ & Maria Luisa Brandi ^1,2

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¹Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, Italy; ²Fondazione FIRMO Onlus, Firenze, Italy; ³Amolyt Pharma, Ecully, France; ⁴University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy; ⁵University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy; ⁶University of Naples Federico II, Department of Clinical Medicine and Surgery, Napoli, Italy; ⁷IRCCS Istituto Auxologico Italiano, Center for Metabolic Bone Diseases and Diabetology, Milano, Italy; ⁸University of Milan, Department of Biomedical, Surgical and Dental Sciences, Milano, Italy; ⁹University of Ferrara, Section of Endocrinology & Internal Medicine, Department of Medical Sciences, Ferrara, Italy, ¹⁰University of Padua, Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova, Italy, ¹¹University of Rome "La Sapienza", Department Experimental Medicine, Section Medical Pathophysiology, Endocrinology and Nutrition, Roma, Italy, ¹²University of Milan, Department of Clinical Sciences and Community Health, Milano, Italy, ¹³University of Messina, Department of Human Pathology Patologia DETEV, Messina, Italy

Introduction: The HypoparaNet database includes 509 patients (110 men and 399 women) with chronic hypoparathyroidism (cHP), recruited and followed in 20 clinical centers in Italy from 2014 onwards. cHP etiology included 363 post-surgical cases (71.3%), 78 idiopathic cases (15.3%), and 64 patients with a genetic background (12.6%). Bone health is an important clinical aspect to be considered in patients with cHP, whose skeleton is exposed both to the cHP-induced alteration of bone mass and microarchitecture and to the occurrence/progression of osteopenia/osteoporosis related to ageing, specifically in post-menopausal (or over 50 years) women.

Patients and Methods: In the HypoparaNet cohort, dual x-ray osteodensitometry (DXA) was available in n=173 cHP patients. Among them, we specifically assessed the prevalence of osteopenia and osteoporosis in relation to menopause (or age below or above 50 years) in cHP women. Osteoporosis was defined as the presence of at least one of the measured bone sites presenting a T-score (or a Z-score for individuals <50 years) <−2.5. Osteopenia was defined as the presence of at least one of the measured bone sites presenting a T-score (or a Z-score for individuals <50 years) <-1.0, and all the measured bone site > −2.5.

Results: Female patients (n=45) at or below 50 years (F≤50) and female patients (n=97) above 50 years (F>50) showed comparable mean values of albumin-adjusted serum calcium, PTH, phosphate, 25(OH) vitamin D, 1,25(OH)₂ vitamin D and magnesium. The overall prevalence of osteopenia was high, and it resulted to be comparable in the F≤50 and F>50 subgroups, averaging 38% and 34%, respectively. The prevalence of osteoporosis was clearly higher in the F>50 group with respect to the F≤50 group, averaging 4% and 24%, respectively.

Conclusions: These real-world data indicate that nearly half of cHP women, who represent the majority of the hypoparathyroid population, exhibit a high prevalence of osteopenia or osteoporosis that increases in relation to age. In this context, new treatment modalities (including PTH replacement therapy) for this patient population should aim at restoring a balanced bone turnover, preventing further bone loss and granting a better bone health at any age.