Normocalcaemic hypoparathyroidism: Prevalence and effect on bone status in older women. the OPUS study

Objective There are no consistent data on the prevalence and bone status of normocalcaemic hypoparathyroidism (NHYPO) as defined by normal adjusted calcium and low PTH level. Our aim was to determine the prevalence and the metabolic bone profile of NHYPO in older women, assessing its evolution over time. The second objective was to evaluate the prevalence of other calcium metabolic disorders. Design The Osteoporosis and Ultrasound Study (OPUS) is a 6-yr prospective study of fracture-related factors. Participants A total of 2419 older women (age 55-79 yrs) and 258 younger women (age 30-40 yrs) participated. Complete follow-up data were available in 1416 subjects. Measurements After calculating the adjusted calcium according to James' formula, we identified 'abnormal' calcium and PTH using Mahalanobis distances and allocated older women into different pathological categories using reference intervals from the healthy young women. Results We identified 57 subjects with NHYPO (2·4%). These women had lower than expected bone turnover as assessed by bone alkaline phosphatase (-14·5%, 95% CI: -26·2 to -3·0, P = 0·007), CTX (-66·3%, 95% CI: -74·0 to -56·4, P < 0·001) and osteocalcin (-36·8%, 95% CI: -45·6 to -26·6, P < 0·001). After 6 years, of the 35 NHYPO subjects with follow-up data, none developed overt hypoparathyroidism and only 15 (0·6%) subjects had persistent evidence of NHYPO. We also identified 86 subjects (3·6%) affected by hyperparathyroid hypercalcaemia. Conclusion This is the first large population-based study to investigate NHYPO in older women. NHYPO is fairly common, not always persistent and is characterized by low bone turnover.