一种未被诊断的表现：原发性甲状旁腺功能亢进的下颌骨丢失

IF 3.6 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Bone Pub Date : 2025-08-05 DOI:10.1016/j.bone.2025.117598

Burcak Cavnar Helvaci , Meltem Horoz , Ceren Karacalik Unver , Aysegul Cavnar , Sema Hepsen , Burcu Candemir , Bekir Ucan , Huseyin Demirci , Erman Cakal

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引用次数: 0

摘要

原发性甲状旁腺功能亢进（PHPT）是一种以甲状旁腺激素（PTH）水平升高为特征的代谢性骨疾病，导致骨密度降低和骨质疏松症风险增加。虽然口腔表现经常被报道，下颌骨质流失及其与全身骨骼健康的关系仍然没有充分的特征。本研究旨在探讨PHPT患者下颌骨丢失及其与骨质疏松症的关系。材料和方法在这项单中心病例对照研究中，纳入了226名参与者（111名PHPT患者和115名年龄和性别匹配的健康对照）。收集临床、实验室和影像学资料，包括全景x线片，使用甲状旁腺下颌指数（PMI）和Klemetti指数（KI）评估下颌骨质流失。采用双能x线骨密度仪（DXA）评估骨密度，诊断骨质疏松症。采用相关分析和logistic回归分析探讨下颌指数与骨质疏松症之间的关系。结果与对照组相比，sphpt患者的PMI值明显降低，KI类型更高级，表明下颌骨质流失更严重。此外，在PHPT组中，骨质疏松症患者的PMI和KI值比未骨质疏松症患者更差。相关分析显示PMI评分与skeleton t评分呈正相关。多因素logistic回归分析发现PMI是PHPT患者骨质疏松症的独立预测因子。结论下颌骨质流失是PHPT患者骨质疏松的潜在早期标志，尤其是PMI值较低。据我们所知，我们的研究是第一个强调PHPT患者下颌骨丢失的重要性及其与骨质疏松症的相关性的研究之一。常规全景x线片，通常在牙科实践中获得，可以为骨质疏松症风险评估提供有价值的辅助信息。

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An underdiagnosed manifestation: Mandibular bone loss in primary hyperparathyroidism

Introduction

Primary hyperparathyroidism (PHPT) is a metabolic bone disorder characterized by elevated parathyroid hormone (PTH) levels, leading to decreased bone mineral density and increased risk of osteoporosis. While oral manifestations are frequently reported, mandibular bone loss and its relationship with systemic bone health remain inadequately characterized. This study aimed to investigate mandibular bone loss in PHPT patients and its association with osteoporosis.

Materials and methods

In this single-center, case-control study, 226 participants (111 PHPT patients and 115 age- and sex-matched healthy controls) were enrolled. Clinical, laboratory, and imaging data were collected, including panoramic radiographs to assess mandibular bone loss using the Parathyroid Mandibular Index (PMI) and the Klemetti Index (KI). Dual-energy X-ray absorptiometry (DXA) was used to assess bone mineral density and diagnose osteoporosis. Correlation and logistic regression analyses were performed to explore associations between mandibular indices and osteoporosis.

Results

PHPT patients had significantly lower PMI values and more advanced KI categories compared to controls, indicating greater mandibular bone loss. Also, in the PHPT group, patients with osteoporosis had worse PMI and KI values than those without osteoporosis. Correlation analysis showed that PMI scores positively correlate with skeleton t scores. Multivariate logistic regression analysis identified PMI as an independent predictor for osteoporosis in PHPT patients.

Conclusion

Mandibular bone loss, particularly indicated by lower PMI values, is a potential early marker for osteoporosis in PHPT patients. To our knowledge, our study is one of the first to highlight the significance of mandibular bone loss in PHPT patients and its correlation with osteoporosis. Routine panoramic radiographs, commonly obtained in dental practice, could provide valuable adjunctive information for osteoporosis risk assessment in this population.

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来源期刊

Bone 医学-内分泌学与代谢

CiteScore

8.90

自引率

4.90%

发文量

264

审稿时长

30 days

期刊介绍： BONE is an interdisciplinary forum for the rapid publication of original articles and reviews on basic, translational, and clinical aspects of bone and mineral metabolism. The Journal also encourages submissions related to interactions of bone with other organ systems, including cartilage, endocrine, muscle, fat, neural, vascular, gastrointestinal, hematopoietic, and immune systems. Particular attention is placed on the application of experimental studies to clinical practice.