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Parathyroid Hormone Levels Help Identify Outcomes Of Hip Breaks In Elderly Patients

According to investigators, an elevated serum parathyroid hormone (PTH) level can help identify the poor early outcomes in older patients who sustain an osteoporotic hip fracture.

The team headed by Dr. Alexander Fisher, with The Canberra Hospital in Australia, measured vitamin D and PTH levels in 287 consecutive patients 60 years of age or older who had a primary diagnosis of low-trauma osteoporotic hip fracture.

Vitamin D deficiency and secondary hyperparathyroidism are very common among the elderly and have been associated with osteoporosis and fractures, Dr. Fisher, senior consultant in geriatrics and ortho-geriatrics, said. Vitamin D insufficiency and secondary hyperparathyroidism are also linked with frailty and increased morbidity, including cardiovascular disorders, diabetes, infections, and cancer, all of which are important contributors to hip fracture outcomes, as well as increased mortality, especially in the elderly.

He reported that however, the study did not evaluate the role of abnormal serum 25(OH) D and PTH levels for the prediction of clinical outcomes in hip fracture patients.

Out of the patients involved, 79.8% had vitamin D deficiency, 29.2% had severe deficiency, and 2.9% had desirable vitamin D levels. Of the total cohort, the PTH level was elevated in 35.5% and in 45.1% of the patients with severe vitamin D deficiency.

Elevated serum PTH concentrations in the group was significantly older, included more women and patients with trochanteric fracture, hypertension, history of stroke, coronary artery disease, and American Society of Anesthesiologists (ASA) score greater than or equal to 3 than the group with PTH levels within the reference range.

After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12), perioperative myocardial injury (OR = 1.05) and length of hospital stay (OR = 1.05), and discharge to a residential care facility (OR=1.07). The only variable was the elevated PTH among multiple demographic, clinical, and laboratory factors that was independently associated with all four outcome measures.

Any of the outcome indicators were not predicted by Vitamin D.

Serum PTH levels are very easy to measure but nonetheless aren’t measured very often because a potential vitamin D deficiency has been the main concern among clinicians, told Dr. Fisher. Treatment is also simple and usually involves addressing vitamin D deficiency, which frequently precedes elevated PTH levels.

He reported that further studies are needed to support the results, to explore underlying pathophysiologic mechanisms, and to determine whether intervention strategies may improve outcomes in older hip fracture patients.