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Associations of primary hyperparathyroidism and physical performance, fall- and fracture risk in elderly men - Mr Os Sweden: PHPT-physical performance, falls and fractures in elderly men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Primary hyperparathyroidism (PHPT) is an endocrine disease associated with deterioration of the skeleton and neuromuscular dysfunction. This study has explored associations between PHPT, physical function and risk of falls and fractures in elderly men.

Method: Serum parameters of calcium homeostasis, physical testing of neuromuscular function (grip strength, time stands, 6 meters walking and 20 cm narrow walking tests), self reported falls during 12 months preceding the testing and self reported fractures were evaluated in 3014 men aged 69 to 81 years in the MrOS Sweden cohort. Subjects were diagnosed with PHPT (n=22) if both albumin adjusted s-calcium and plasma parathyroid hormone (p-iPTH) were above normal in absence of renal failure and vitamin-D insufficiency. To evaluate impact of minor calcium disturbance, suggesting normocalcemic HPT, the total cohort were divided into subjects with inappropriately elevated iPTH (IEP-group), based on above median value of both s-calcium (2.34mmol/L) and iPTH (4.24 pmol/L) ( n=387 minus the 22 with PHPT, in total 365) and  subjects with normal calcium homeostasis (controls, n=1848). Group comparisons were made between PHPT-group and controls and IEP-group and controls.

Results: The IEP-group performed inferior in all but one of the muscular functioning tests (all p <0.01, respectively) and the PHPT-group performed inferior in the time stand test (p<0.05). There were no significant group differences in fall or fracture prevalence.

Conclusion: Elderly men with calcium disturbance, suggesting normocalcemic PHPT, had inferior physical performance than men with normal calcium homeostasis but it was not associated with higher fall or fracture prevalence.

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-152226OAI: oai:DiVA.org:uu-152226DiVA: diva2:413037
Available from: 2011-04-27 Created: 2011-04-27 Last updated: 2011-07-01
In thesis
1. Primary Hyperparathyroidism: Prevalence and Associated Morbidity in Middle-Aged Women and Elderly Men
Open this publication in new window or tab >>Primary Hyperparathyroidism: Prevalence and Associated Morbidity in Middle-Aged Women and Elderly Men
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Primary hyperparathyroidism (PHPT) is a common endocrine disease, existing in both genders and in all age groups. Postmenopausal women are at particular risk of developing the disease and estrogen decline after menopause is suggested to affect the progress. Although PHPT is mild in its presentation with subtle or no subjective symptoms, it is associated with an increased risk of associated morbidity and also mortality i.e cardiovascular complications, psychiatric instability, concomitant metabolic abnormalities, obesity and decrease in bone mineral density. The current cure is surgical removal of the diseased gland/s, but other medical alternatives have been investigated. The disease is thoroughly explored in postmenopausal women but less is known about other populations groups.

Since progression of the disease generally is slow, the underlying disturbance of the calcium homeostasis can be suspected to have been established a long time prior to diagnose with potential to affect associated morbidity. The general aim of this thesis is to clarify the expression of PHPT in premenopausal women and in elderly men and to explore how frequent the disease in these populations occurs. The women and men were investigated through population-based studies.

Baseline data and prevalence of PHPT in premenopausal women age 40-50 years were studied (Paper I), the prevalence was 5.1% in this population and was associated with decreased bone mineral density and associated obesity. In a three years follow up of the female cohort, the effects of menopausal transition and associated morbidity was investigated (Paper II). The prevalence and expression of PHPT in men between 69 and 81 years and impact on bone mineral density, physical performance, fall and fracture prevalence was explored through data from Mr Os Sweden (Papers III and IV). In this population prevalence of PHPT was 0.73% and associated with lower bone mineral density and inferior physical performance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 678
Keyword
Primary hyperparathyroidism, menopausal, bone mineral density, physical performance, parathyroid hormone
National Category
Medical and Health Sciences
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-152270 (URN)978-91-554-8097-4 (ISBN)
Public defence
2011-06-11, Grönwallssalen, Akademiska sjukhuset, ingång 70, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-20 Created: 2011-04-27 Last updated: 2011-07-01Bibliographically approved

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