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PTH and bone material strength in hypoparathyroidism as measured by impact microindentation

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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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References

  1. Hernandez CJ, Gupta A, Keaveny TM (2006) A biomechanical analysis of the effects of resorption cavities on cancellous bone strength. J Bone Miner Res 21:1248–1255

    Article  Google Scholar 

  2. Hernandez CJ, Keaveny TM (2006) A biomechanical perspective on bone quality. Bone 39:1173–1181

    Article  CAS  Google Scholar 

  3. Garnero P (2015) The role of collagen organization on the properties of bone. Calcif Tissue Int 97:229–240

    Article  CAS  Google Scholar 

  4. Langdahl BL, Mortensen L, Vesterby A, Eriksen EF, Charles P (1996) Bone histomorphometry in hypoparathyroid patients treated with vitamin D. Bone 18:103–108

    Article  CAS  Google Scholar 

  5. Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J Jr, Silverberg SJ, Bilezikian JP (2008) Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 23:2018–2024

    Article  CAS  Google Scholar 

  6. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2015) The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res 30:1738–1744

    Article  CAS  Google Scholar 

  7. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2013) Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res 28:2277–2285

    Article  Google Scholar 

  8. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2014) Postsurgical hypoparathyroidism--risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res 29:2504–2510

    Article  Google Scholar 

  9. Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M (2012) Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 97:4507–4514

    Article  CAS  Google Scholar 

  10. Chawla H, Saha S, Kandasamy D, Sharma R, Sreenivas V, Goswami R (2017) Vertebral fractures and bone mineral density in patients with idiopathic hypoparathyroidism on long-term follow-up. J Clin Endocrinol Metab 102:251–258

    PubMed  Google Scholar 

  11. Bridges D, Randall C, Hansma PK (2012) A new device for performing reference point indentation without a reference probe. RSI 83:044301

    Google Scholar 

  12. Diez-Perez A, Guerri R, Nogues X et al (2010) Microindentation for in vivo measurement of bone tissue mechanical properties in humans. J Bone Miner Res 25:1877–1885

    Article  Google Scholar 

  13. Nilsson AG, Sundh D, Johansson L, Nilsson M, Mellstrom D, Rudang R, Zoulakis M, Wallander M, Darelid A, Lorentzon M (2017) Type 2 diabetes mellitus is associated with better bone microarchitecture but lower bone material strength and poorer physical function in elderly women: a population-based study. J Bone Miner Res 32:1062–1071

    Article  Google Scholar 

  14. Diez-Perez A, Bouxsein ML, Eriksen EF, Khosla S, Nyman JS, Papapoulos S, Tang SY (2016) Technical note: recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation. Bone Reports 5:181–185

    Article  CAS  Google Scholar 

  15. Fantner GE, Hassenkam T, Kindt JH et al (2005) Sacrificial bonds and hidden length dissipate energy as mineralized fibrils separate during bone fracture. Nat Mater 4:612–616

    Article  CAS  Google Scholar 

  16. Allen MR, McNerny EM, Organ JM, Wallace JM (2015) True gold or pyrite: a review of reference point indentation for assessing bone mechanical properties in vivo. J Bone Miner Res 30:1539–1550

    Article  Google Scholar 

  17. Malgo F, Hamdy NA, Papapoulos SE, Appelman-Dijkstra NM (2015) Bone material strength as measured by microindentation in vivo is decreased in patients with fragility fractures independently of bone mineral density. J Clin Endocrinol Metab 100:2039–2045

    Article  CAS  Google Scholar 

  18. Rudang R, Zoulakis M, Sundh D, Brisby H, Diez-Perez A, Johansson L, Mellstrom D, Darelid A, Lorentzon M (2016) Bone material strength is associated with areal BMD but not with prevalent fractures in older women. Osteoporos Int 27:1585–1592

    Article  CAS  Google Scholar 

  19. Rubin MR, Cusano NE, Fan WW, Delgado Y, Zhang C, Costa AG, Cremers S, Dworakowski E, Bilezikian JP (2016) Therapy of hypoparathyroidism with PTH(1-84): a prospective six year investigation of efficacy and safety. J Clin Endocrinol Metab 101:2742–2750

    Article  CAS  Google Scholar 

  20. Rubin MR, Zhou H, Cusano NE, Majeed R, Omeragic B, Gomez M, Nickolas TL, Dempster DW, Bilezikian JP (2018) The effects of long-term administration of rhPTH(1-84) in hypoparathyroidism by bone histomorphometry. J Bone Miner Res 33:1931–1939

    Article  CAS  Google Scholar 

  21. Hernandez CJ, van der Meulen MC (2017) Understanding bone strength is not enough. J Bone Miner Res 32:1157–1162

    Article  Google Scholar 

  22. Mellibovsky L, Prieto-Alhambra D, Mellibovsky F, Guerri-Fernandez R, Nogues X, Randall C, Hansma PK, Diez-Perez A (2015) Bone tissue properties measurement by reference point indentation in clucocorticoid-induced osteoporosis. J Bone Miner Res 30:1651–1656

    Article  CAS  Google Scholar 

  23. Sundh D, Nilsson M, Zoulakis M, Pasco C, Yilmaz M, Kazakia GJ, Hellgren M, Lorentzon M (2018) High-impact mechanical loading increases bone material strength in postmenopausal women-a 3-month intervention study. J Bone Miner Res 33:1242–1251

    Article  Google Scholar 

  24. Guerri-Fernandez R, Lerma-Chippirraz E, Fernandez Marron A et al (2018) Bone density, microarchitecture, and tissue quality after 1 year of treatment with tenofovir disoproxil fumarate. AIDS 32:913–920

    PubMed  Google Scholar 

  25. Rubin MR, Dempster DW, Sliney J Jr et al (2011) PTH(1-84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism. J Bone Miner Res 26:2727–2736

    Article  CAS  Google Scholar 

  26. Misof BM, Roschger P, Dempster DW, Zhou H, Bilezikian JP, Klaushofer K, Rubin MR (2016) PTH(1-84) Administration in hypoparathyroidism transiently reduces bone matrix mineralization. J Bone Miner Res 31:180–189

    Article  CAS  Google Scholar 

  27. Sosa DD, Eriksen EF (2017) Reduced bone material strength is associated with increased risk and severity of osteoporotic fractures. an impact microindentation study. Calcif Tissue Int 101:34–42

    Article  CAS  Google Scholar 

  28. Rozental TD, Walley KC, Demissie S, Caksa S, Martinez-Betancourt A, Parker AM, Tsai JN, Yu EW, Bouxsein ML (2018) Bone material strength index as measured by impact microindentation in postmenopausal women with distal radius and hip fractures. J Bone Miner Res 33:621–626

    Article  Google Scholar 

  29. Duarte Sosa D, Vilaplana L, Guerri R, Nogues X, Wang-Fagerland M, Diez-Perez A, E FE (2015) Are the high hip fracture rates among Norwegian women explained by impaired bone material properties? J Bone Miner Res 30:1784–1789

    Article  CAS  Google Scholar 

  30. Uppuganti S, Granke M, Manhard MK, Does MD, Perrien DS, Lee DH, Nyman JS (2017) Differences in sensitivity to microstructure between cyclic- and impact-based microindentation of human cortical bone. J Orthop Res 35:1442–1452

    Article  Google Scholar 

  31. Abraham AC, Agarwalla A, Yadavalli A, Liu JY, Tang SY (2016) Microstructural and compositional contributions towards the mechanical behavior of aging human bone measured by cyclic and impact reference point indentation. Bone 87:37–43

    Article  Google Scholar 

  32. Johansson L, Sundh D, Zoulakis M, Rudang R, Darelid A, Brisby H, Nilsson AG, Mellstrom D, Lorentzon M (2018) The prevalence of vertebral fractures is associated with reduced hip bone density and inferior peripheral appendicular volumetric bone density and structure in older women. J Bone Miner Res 33:250–260

    Article  CAS  Google Scholar 

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Funding

This study received funding from NIH R01 DK069350 and K24-DK074457.

Author information

Author notes

  1. G. Tabacco

    Present address: Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy

  2. L. Bandeira

    Present address: Fleury Group, Sao Paulo, SP, Brazil

Authors and Affiliations

  1. Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA

    J.R. Starr, G. Tabacco, R. Majeed, B. Omeragic, L. Bandeira & M.R. Rubin

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  1. J.R. Starr
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  2. G. Tabacco
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  3. R. Majeed
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  4. B. Omeragic
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  6. M.R. Rubin
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Corresponding author

Correspondence to M.R. Rubin.

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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.

Conflicts of interest

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

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