scholarly journals Endogenous DHEAS is Causally Linked with Lumbar Spine Bone Mineral Density and Forearm Fractures in Women

2021 ◽  
Author(s):  
Johan Quester ◽  
Maria Nethander ◽  
Anna Eriksson ◽  
Claes Ohlsson
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Hip Fractures ◽  
Causal Effect ◽  
Forearm Fracture ◽  
P Value ◽  
Forearm Fractures ◽  
Mineral Density ◽  
Dhea Treatment ◽  
Female Specific

Abstract Context A recent pooled analysis of four clinical trials demonstrated that treatment with dehydroepiandrosterone (DHEA) increases lumbar spine BMD (LS-BMD) in women. The causal effect of endogenous adrenal-derived DHEA-sulphate (DHEAS) on LS-BMD and fracture risk in women is unknown. Objective To determine whether circulating DHEAS is causally associated with LS-BMD and fracture risk in women. Methods A two-sample mendelian randomization study using genetic predictors of serum DHEAS derived from the largest available female-specific genome wide association study (GWAS) meta-analysis (n=8 565). Genetic associations with DXA-derived BMD (n=22 900) were obtained from female specific GWAS summary statistics available from the GEFOS consortium while individual-level data of 238 565 women of white ancestry from the UK Biobank were used for associations with fractures (11 564 forearm fractures, 2 604 hip fractures) and estimated heel BMD by ultrasound (eBMD). Results A 1 standard deviation (SD) genetically instrumented increase in log serum DHEAS levels was associated with a 0.21 SD increase in LS-BMD (P-value: 0.01) and a 0.08 SD increase in eBMD (P-value: <0.001). Genetically predicted DHEAS decreased forearm fracture risk (odds ratio (OR): 0.70, 95% confidence interval (CI): 0.55-0.88 per SD increase in DHEAS) while no significant causal association with hip fractures was observed. Conclusions Genetically predicted serum DHEAS increases LS-BMD and decreases forearm fracture risk in women. Based on the results of the present study and previous RCTs of DHEA treatment, we propose that both endogenous adrenal-derived DHEA(S) and pharmacological DHEA treatment improve bone health in women.

scholarly journals MDCT-Based Finite Element Analyses: Are Measurements at the Lumbar Spine Associated with the Biomechanical Strength of Functional Spinal Units of Incidental Osteoporotic Fractures along the Thoracolumbar Spine?

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 455
Author(s):  
Nico Sollmann ◽  
Nithin Manohar Rayudu ◽  
Long Yu Yeung ◽  
Anjany Sekuboyina ◽  
Egon Burian ◽  
...  
Keyword(s):  
Finite Element ◽  
Lumbar Spine ◽  
Fracture Risk ◽  
Thoracolumbar Spine ◽  
Areal Bone Mineral Density ◽  
Mineral Density ◽  
Osteoporotic Vertebral Fractures ◽  
The Mean ◽  
Biomechanical Strength

Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD–L2-IVD–L3 (FSU_L1–L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1–L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1–L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.

scholarly journals POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 294.2-294
Author(s):  
D. Ciardo ◽  
P. Pisani ◽  
F. A. Lombardi ◽  
R. Franchini ◽  
F. Conversano ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
P Value ◽  
T Score ◽  
Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

scholarly journals POS1112 COMPARISON OF TWO APPROACHES IN FRACTURES RISK ASSESSMENT IN WOMEN WITH RHEUMATOID ARTHRITIS AND GLUCOCORTICOID USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 836.1-836
Author(s):  
N. Grygorieva ◽  
V. Povoroznyuk
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Assessment ◽  
Clinical Practice ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Fracture Risk Assessment ◽  
Lifestyle Modifications ◽  
Mineral Density ◽  
Dxa Scan

Background:Nowadays, FRAX is the most useful tool for osteoporotic fracture risk assessment that is included in many guidelines. Rheumatoid arthritis (RA) and glucocorticoid (CG) use are two crucial factors for osteoporotic fractures included in FRAX algorithm. According to the last ACR guidelines for the treatment of GC-induced osteoporosis [1], it was recommended to divide the patients into three groups of fracture risk (high, medium and low) that have a great impact on treatment decision. Recently, we received own Ukrainian thresholds [2] for the national version of FRAX that are age-dependent and now widely used in clinical practice.Objectives:Our study was aimed to compare two approaches (ACR-2017 and Ukrainian (2019) recommendations) in fracture risk assessment in women with RA and GC use.Methods:We examined 195 females with RA aged 40-89 years old who took GC (at dose ≥5 mg/d for ≥3 months) due to RA. The 10-year probabilities of major osteoporotic (MOFs) and hip fractures (HFs) were calculated with and without bone mineral density (BMD) using the Ukrainian FRAX model [3]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; T and Z scores were calculated (DISCOVERY Wi, Hologic, Inc., USA).Results:FRAX indexes for MOFs and HFs without BMD in patients with RA and GC were (Me [25-75Q]) 12.0 [8.1-18.0] and 4.2 [1.7-7.2] %. The correspondent FRAX indexes with BMD were 13.5 [8.5-20.0] and 5.1 [1.8-8.7] %.50 % of examined women had previous fractures and 20 % had previous vertebral fractures. BMD of the femoral neck consisted of 0.62±0.13 and L1-L4 BMD was 0.85±0.15 g/cm2. 89 % of females had low BMD at the lumbar spine and / or femoral neck (49 % osteoporosis and 40 % osteopenia).61 % of women required antiosteoporotic treatment according to ACR-2017 guideline (17.4 % of them a hadhigh risk of MOF and 43.1 % moderate one) without BMD measurement and 64 % of subjects after DXA scan.According to Ukrainian national guideline, 57 % of patients required antiosteoporotic treatment without BMD measurement and 42 % – after additional DXA examination. After BMD measurement in subjects who required the DXA scan, 78.2 % of females with RA and GC use required antiosteoporotic treatment (additionally to calcium and vitamin D, lifestyle modifications).Conclusion:Approximately 60 % of subjects with RA and GC use required antiosteoporotic treatment without additional DXA measurement according to correspondent FRAX indexes from both guidelines. The proportion of women requiring treatment after DXA scan is slightly higher according to Ukrainian recommendations. It proves that both of them can be used effectively in daily clinical practice for fracture risk assessment in females with RA.References:[1]Buckley L, Guyatt G, Fink HA, Cannon M et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology, 2017;69(8), 1521–1537. DOI:10.1002/art.40137[2]Povoroznyuk V, Grygorieva N, Kanis JA et al. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis. Pain. Joint. Spine. 2019;9(4):7-16. DOI: 10.22141/2224-1507.9.4.2019.191921[3]Povoroznyuk VV, Grygorieva NV, Kanis JA et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos. 2017;12(1):53. DOI: 10.1007/s11657-017-0343-2.Disclosure of Interests:Nataliia Grygorieva Consultant of: Servier, Redis, Vladyslav Povoroznyuk: None declared.

P0911TO STUDY CHANGES IN BONE MINERAL DENSITY POST RENAL TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
PRASHANT MALVIYA ◽  
Soma Sekhar Mudigonda
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Renal Transplantation ◽  
Lumbar Spine ◽  
Renal Transplant ◽  
Bone Mineral ◽  
Hip Joint ◽  
P Value ◽  
Mineral Density ◽  
Dexa Scan

Abstract Background and Aims Chronic kidney disease patients get affected by mineral bone disease in view of changes in various biochemical parameters. After transplantation there are changes in these parameters with additional effect of immunosuppression on bone mineral density. My study was to observe changes in biochemical parameters like calcium, phosphorus, vitamin D, parathyroid hormone, alkaline phosphatase and compare bone mineral density with the help of DEXA scan post renal transplantation after 3 and 6 months. It was a prospective observational comparative study. Aim of my study is to evaluate changes in Bone Mineral Density post renal transplantation Method Study was conducted at Apollo Tertiary care Hospital, Hyderabad which caters to rural as well as urban population in southern parts of India. This study was carried out form June 2017 to Dec 2018. Total 40 patients were included in study and they were followed up for the period of 6 months and underwent sets of investigations to assess their bone mineral density. Biochemical variables consist of calcium, phosphorus, alkaline phosphatase, vitamin D level and iPTH. Biochemical variables were classified into hypo, normal or hyper based on their lab values. iPTH values were considered high if value was nine times the upper limit of normal or low if value was less than two times the upper limit of normal. DEXA scan results were classified into normal, osteopenia and osteoporosis based on their t value. Results Study showed that patients who got admitted for transplant belong to age group of 31 – 50 yrs (39.8 +/- 12.8 yrs) predominantly male patients 30 (75%). In 25% patients (10) we were unable to find out native kidney disease shown as CKD (u). Other common causes were DM, ADPKD, CGN or CIN. Most patients were undergoing dialysis for more than 1 year, 47.5% (19) had significant loss of BMD as compared to patients whose dialysis was &lt;1 year (p value 0.498 and 0.05). Hypocalcemia was predominantly seen in pretransplant period 26 (65%) but as the patient followed up level improved with few developing hypercalcemia 4 (10%) after 6 months. Hyperphosphotemia was seen in 19 (47.5%) patients before transplant while hypophosphatemia in 4 (10%) patients 6 months post transplantation, others had normal phosphorus level. Patients were on calcium and vitamin D supplements developed sufficiency to high level of vitamin D 33 (82.5%) patients 6 months post renal transplant. In iPTH around 12 (30%) of patients were having iPTH &gt;150 pg/dl after 6 months of transplant. Majority presented for transplant detected to have osteoporosis and osteopenia at lumbar spine 31 (77.5%) and hip joint 27 (67.5%) with fracture risk 4 to 8 times of normal population. There was 8% and 10% increase in number of patients having osteoporosis at lumbar spine and hip joint respectively post-transplant. There was loss of 5.5% (mean t score at 0 month -1.98 and at 6 month -2.09) BMD at lumbar spine and 1.7% (mean t score at 0 month -1.83 and at 6 month -1.9) BMD at hip joint. Net loss of BMD was 3.6% over the period of 6 months. This accounts to increased risk of fractures post renal transplant. Biochemical variable in the form of iPTH has shown to have significant association with DEXA scan at lumbar spine (p value 0.01) and hip joint (p value 0.00) before and after transplant (p value of 0.01 and 0.00) though there was fall in iPTH level. Conclusion Pretransplant bone disease remains predominant cause of post-transplant bone disease with significant association with iPTH. Hypophosphatemia, hypercalcemia and high Vitamin D level are common findings in post-transplant period upto 6 months. Early use of DEXA scan along with follow up of biochemical variables can help to prognosticate and decide treatment strategies to reduce fracture risk in renal transplant recipients.

scholarly journals Impact of postpartum tenofovir-based antiretroviral therapy on bone mineral density in breastfeeding women with HIV enrolled in a randomized clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246272
Author(s):  
Lynda Stranix-Chibanda ◽  
Camlin Tierney ◽  
Dorothy Sebikari ◽  
Jim Aizire ◽  
Sufia Dadabhai ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Antiretroviral Therapy ◽  
Bone Mineral ◽  
Mean Difference ◽  
P Value ◽  
Postnatal Exposure ◽  
Mineral Density ◽  
African Countries ◽  
To Receive

Objectives We set out to evaluate the effect of postnatal exposure to tenofovir-containing antiretroviral therapy on bone mineral density among breastfeeding women living with HIV. Design IMPAACT P1084s is a sub-study of the PROMISE randomized trial conducted in four African countries (ClinicalTrials.gov number NCT01066858). Methods IMPAACT P1084s enrolled eligible mother-infant pairs previously randomised in the PROMISE trial at one week after delivery to receive either maternal antiretroviral therapy (Tenofovir disoproxil fumarate / Emtricitabine + Lopinavir/ritonavir–maternal TDF-ART) or administer infant nevirapine, with no maternal antiretroviral therapy, to prevent breastmilk HIV transmission. Maternal lumbar spine and hip bone mineral density were measured using dual-energy x-ray absorptiometry (DXA) at postpartum weeks 1 and 74. We studied the effect of the postpartum randomization on percent change in maternal bone mineral density in an intention-to-treat analysis with a t-test; mean and 95% confidence interval (95%CI) are presented. Results Among 398/400 women included in this analysis, baseline age, body-mass index, CD4 count, mean bone mineral density and alcohol use were comparable between study arms. On average, maternal lumbar spine bone mineral density declined significantly through week 74 in the maternal TDF-ART compared to the infant nevirapine arm; mean difference (95%CI) -2.86 (-4.03, -1.70) percentage points (p-value <0.001). Similarly, maternal hip bone mineral density declined significantly more through week 74 in the maternal TDF-ART compared to the infant nevirapine arm; mean difference -2.29% (-3.20, -1.39) (p-value <0.001). Adjusting for covariates did not change the treatment effect. Conclusions Bone mineral density decline through week 74 postpartum was greater among breastfeeding HIV-infected women randomized to receive maternal TDF-ART during breastfeeding compared to those mothers whose infants received nevirapine prophylaxis.

Comparison of Bone Mineral Density at Hip and Lumbar Spine in Patients with Femoral Neck Fractures and Pertrochanteric Fractures

2021 ◽  
Vol 23 (1) ◽  
pp. 45-49
Author(s):  
Chulin Chewakidakarn ◽  
Varah Yuenyongviwat
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Dual Energy ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
Mineral Density ◽  
Pertrochanteric Fractures ◽  
X Ray ◽  
Total Hip

Background. Geriatric hip fractures, including femoral neck and pertrochanteric fractures, are common nowadays, which is related to increasing numbers of elderly people worldwide. Osteoporosis is an important risk factor associated with hip fractures. This study aimed to describe the association of hip fractures and osteoporosis at different BMD measurement sites and determine any differences between these two types of hip fracture. Material and methods. A retrospective study conducted in a university hospital in the south of Thailand enrolled 223 patients aged over 50 years with low-energy trauma hip fractures. Each patient had undergone dual energy x-ray absorptiometry (DXA) within 2 weeks of injury. T-scores were recorded for the total hip, femoral neck and lumbar spine areas and classified as normal, osteopenia and osteoporosis according to WHO osteoporosis diagnostic criteria. Results. The highest proportion of T-scores in the osteoporotic range were registered at the femoral neck (68.6%) compared to total hip (52.9%) and lumbar spine (47.7%). At least 31.4% of patients were in the non-osteoporotic range. No significant differences were found at all sites of BMD measurement between the two types of fracture. Conclusions. 1. At least 1/3 of patients with geriatric hip fractures had their T-scores in the normal to oste­ope­nic range. 2. BMD in different areas is not different between types of hip fractures.

Automated and Precise Bone Mineral Density Prediction and Fracture Risk Assessment using Hip/Lumbar Spine Plain Radiographs via Learning Deep Image Signatures and Correlations

2021 ◽  
Author(s):  
Chen-I Hsieh ◽  
Kang Zheng ◽  
Chihung Lin ◽  
Le Lu ◽  
Weijian Li ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Risk Assessment ◽  
Lumbar Spine ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Assessment Tool ◽  
Fracture Risk Assessment ◽  
Mineral Density ◽  
Spine Radiographs ◽  
Automated Tool

Abstract Dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool are recommended tools for osteoporotic fracture risk evaluation, but are underutilized. We present a novel and fully-automated tool to identify fractures, predict bone mineral density (BMD), and evaluate fracture risk using plain pelvis and lumbar spine radiographs. The performance of this tool were evaluated in 1639 and 11908 patients with pelvis or lumbar spine radiographs and DXA, respectively. The model was well calibrated for hip and spine BMD assessments with minimal or no bias. The area under the curve and accuracy were 0.89 and 92.4% for hip osteoporosis, 0.87 and 86.8% for spine osteoporosis, 0.92 and 94.6% for high 10-year major fracture risk, and 0.92 and 92.2% for high hip fracture risk, respectively. The success rates of our automated algorithm a real-world test were 85.3% and 90.4% for hip and spine, respectively. The clinical use of this automated tool may increase the likelihood of identifying high-risk patients in previously unscreened populations.

Long-Term Skeletal Outcomes of Primary Hyperparathyroidism Patients After Treatment with Parathyroidectomy: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 50 (03) ◽  
pp. 242-249 ◽  
Author(s):  
Lu Zhang ◽  
Xiaomei Liu ◽  
Hongwei Li
Keyword(s):  
Lumbar Spine ◽  
Primary Hyperparathyroidism ◽  
Fracture Risk ◽  
Weighted Mean Difference ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Mineral Density ◽  
Risk Of Fracture ◽  
Statistical Heterogeneity

AbstractThe aim of the study was to assess and define the association between parathyroidectomy (PTX) and long-term skeletal outcomes in primary hyperparathyroidism (PHPT) patients. PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched up to June 31, 2017, without language restriction. Any study comparing skeletal outcomes [fracture risk or bone mineral density (BMD)] of PHPT patients after more than 12 months of PTX treatment versus non-PTX treatment was included. Pooled relative risks or odds ratios with 95% confidence intervals and weighted mean difference were calculated using random-effects models irrespective of statistical heterogeneity assessed by I2 statistic. Finally, 5 randomized controlled trials (RCTs, n=584) and 10 cohort studies (CSs, n=12202) were included. CSs suggest PTX treatment versus non-PTX treatment is significantly associated with 36% reduction in the risk of fracture, with no heterogeneity, and an increase in the lumbar spine change by 0.55 WMD, with no heterogeneity. RCTs indicate PTX treatment versus non-PTX treatment is significantly associated with BMD change of 0.97 WMD at the lumbar spine with substantial heterogeneity, and 1.23 WMD at the femoral neck with no heterogeneity. The existing CSs indicate PTX-treatment versus non-PTX-treatment might reduce the risk of fracture in PHPT patients. The existing RCTs do not provide sufficient or precise evidence that PTX-treatment affects the fracture risk of PHPT patients, but offer data that subsets of patients who could potentially benefit from PTX-treatment can be identified.

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