The following is a summary of “Trabecular Bone Score as a More Sensitive Tool to Evaluate Bone Involvement in MEN1-related Primary Hyperparathyroidism,” published in the January 2024 issue of Endocrinology by Song, et al.

Multiple endocrine neoplasia type 1-related primary hyperparathyroidism (MHPT) presents distinct skeletal involvement compared to sporadic primary hyperparathyroidism (SHPT). Trabecular bone score (TBS) is a texture parameter reflecting trabecular bone damage, offering potential insights into MHPT-related skeletal alterations. For a study, researchers sought to delineate the clinical characteristics, particularly skeletal involvement, in patients with MHPT versus SHPT.

Clinical data from 120 MHPT patients were retrospectively compared with 360 SHPT patients over the same period. Dual-energy X-ray absorptiometry (DXA) was performed in a subset of MHPT patients, with bone mineral density (BMD) and calculated TBS derived from lumbar spine DXA images compared to matched SHPT patients.

While MHPT patients exhibited a longer disease duration, their age at hospital visits was significantly lower than that of SHPT patients (43.5 [interquartile range, 31.5-52.0] vs. 52.0 [interquartile range, 40.5-61.0], P < .001). MHPT patients showed a lower proportion of skeletal involvement compared to SHPT patients. However, in MHPT cases with available BMD data (n = 86), there was no significant difference in skeletal involvement compared to gender- and age-matched SHPT cases. However, BMD and TBS in lumbar spines were lower in MHPT patients than in SHPT patients (BMD: 0.91 ± 0.18 g/cm² vs. 1.01 ± 0.17 g/cm2; TBS: 1.22 ± 0.14 vs. 1.29 ± 0.11, P < .001), TBS revealed bone microstructure damage in 15 out of 34 MHPT patients with normal BMD.

MHPT patients exhibited more severe cancellous bone microarchitecture damage, as indicated by TBS, suggesting TBS as a sensitive supplemental index, alongside BMD, for assessing bone involvement risk in MHPT patients.

Reference: academic.oup.com/jcem/article-abstract/109/1/135/7237041