Assessment of bone microarchitecture in postmenopausal women with primary hyperparathyroidism using trabecular bone score

Nazife Tuzun Ersan; Emetullah Cindil; Hulya Nur Sodan; Ethem Turgay Cerit; Mehmet Muhittin Yalcin; Alev Eroglu Altinova; Fusun Balos Toruner; Ayhan Karakoc; Mujde Akturk

doi:10.1016/j.jocd.2026.101716

Assessment of bone microarchitecture in postmenopausal women with primary hyperparathyroidism using trabecular bone score

J Clin Densitom. 2026 May 13;29(3):101716. doi: 10.1016/j.jocd.2026.101716. Online ahead of print.

Authors

Nazife Tuzun Ersan¹, Emetullah Cindil², Hulya Nur Sodan³, Ethem Turgay Cerit³, Mehmet Muhittin Yalcin³, Alev Eroglu Altinova³, Fusun Balos Toruner³, Ayhan Karakoc³, Mujde Akturk³

Affiliations

¹ Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye. Electronic address: nazife.tuzun@gmail.com.
² Department of Radiology, Gazi University Faculty of Medicine, Ankara, Türkiye.
³ Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Türkiye.

PMID: 42208153
DOI: 10.1016/j.jocd.2026.101716

Abstract

Purpose: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that affects bone structure. Several methods are available to evaluate bone microarchitecture, and among these, the Trabecular Bone Score (TBS) provides an indirect assessment through textural analysis of lumbar spine Dual-energy X-ray absorptiometry (DXA) images. Our study aimed to assess the effects of PHPT on bone in postmenopausal women using bone mineral density (BMD) and TBS, and to evaluate the relationship between TBS, BMD, clinical characteristics, and biochemical parameters.

Method: The clinical characteristics, laboratory findings, and DXA imaging results of 118 postmenopausal women with PHPT were retrospectively analyzed, and TBS analyses were performed.

Results: A total of 118 patients were included in this study. Among them, 92 (77.9%) had TBS≤1.35, with a mean TBS value of 1.23±0.12, indicating an impaired bone microarchitecture. Additionally, 55 patients (46.6%) met the diagnostic criteria for osteoporosis, and 77.1% of the overall cohort were asymptomatic at presentation. Patients with TBS≤1.35 had lower BMD at the lumbar spine, femur, and radius and were more frequently diagnosed with osteoporosis (p < 0.05). A positive correlation was observed between TBS and BMD in all measured skeletal areas (p < 0.05). BMD values were significantly lower in symptomatic patients than in asymptomatic patients (p < 0.05), whereas no statistically significant difference was found in TBS between the two groups (p > 0.05). TBS values were also significantly lower in patients recommended for surgical treatment than in those under follow-up (p = 0.005).

Conclusion: Bone microarchitecture is affected in patients with asymptomatic PHPT. To accurately assess the effects of PHPT on bone, bone microarchitecture should also be evaluated.

Keywords: Bone mineral Density; Osteoporosis; Postmenopausal women; Primary Hyperparathyroidism; Trabecular bone score.