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Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study

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Abstract

Purpose

Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF.

Methods

84 patients (44 males, median age 48.5 years, range 43–65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6–12 months during the study period.

Results

At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001).

Conclusions

This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.

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Authors and Affiliations

  1. Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

    M. Cellini, S. Piccini, F. Carrone, A. G. Lania & G. Mazziotti

  2. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    A. G. Lania & G. Mazziotti

  3. Endocrinology Unit, ASST Carlo Poma, Mantova, Italy

    R. Olivetti

  4. Cardiology Unit, ASST Carlo Poma, Mantova, Italy

    N. Cicorella & M. Aroldi

  5. Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

    G. Ferrante & D. Pini

  6. Department of Medical-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy

    M. Cellini & M. Centanni

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  1. M. Cellini
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  2. S. Piccini
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Correspondence to A. G. Lania.

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All the authors certify that they do not have a conflict of interest that is relevant to the subject matter or materials included in this work.

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The project was approved by the Ethical Commitee of Cremona, Mantova and Lodi, the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments and the patients gave informed consent to the study.

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Cellini, M., Piccini, S., Ferrante, G. et al. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 43, 1561–1569 (2020). https://doi.org/10.1007/s40618-020-01237-1

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