BONE INSUFFICIENCY FRACTURES AS AN INAUGURAL MANIFESTATION OF PRIMARYHYPERPARATHYROIDISM

Primary hyperparathyroidism causes excessive bone resorption with a de crease in bone mineral density. Fractures of the vertebras and appendi cular bones, however, seem uncommon, even in the long term. We report three patients who presented with bone insufficiency fractures as the inaugural symptom of primary hyperparathyroidism. The three patients w ere women, aged 62, 65 and 86 years, respectively, who presented with fractures of the medial tibial plateau, femoral neck or femoral neck a nd tarsus. Laboratory tests showed hypercalcemia, hypophosphatemia and elevated parathyroid hormone levels. Apart from confusion in the 86-y ear-old patient, there were no clinical manifestations. A bone biopsy obtained in one patient showed increased resorption parameters with no loss of bone trabecular volume; the two other patients underwent abso rptiometry, which disclosed a marked decrease in bone mineral density at the spine and femoral neck. There were no risk factors for osteopen ia apart from advanced age and female gender. A parathyroid adenoma wa s removed surgically in all three cases. Vitamin D deficiency was a co ncomitant abnormality that probably exacerbated the adverse effects of hyperparathyroidism on the skeleton.