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Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden

Journal article
Authors Sofia Dalemo
Robert Eggertsen
P. Hjerpe
E. G. Almqvist
Kristina Bengtsson Boström
Published in Scandinavian Journal of Primary Health Care
Volume 36
Issue 2
Pages 198-206
ISSN 0281-3432
Publication year 2018
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 198-206
Language en
Keywords Hypercalcaemia, absorptiometry, bone density, osteoporosis, case control studies, primary health, asymptomatic primary hyperparathyroidism, mild primary, hyperparathyroidism, 4th international workshop, swedish primary-care, induced osteoporosis, management, diagnosis, parathyroidectomy, prevention, fracture, Health Care Sciences & Services, General & Internal Medicine
Subject categories Health Sciences


Objective: Elevated calcium concentration is a commonly used measure in screening analyses for primary hyperparathyroidism (pHPT) and cancer. Low bone mineral density (BMD) and osteoporosis are common features of pHPT and strengthen the indication for parathyroidectomy. It is not known whether an elevated calcium concentration could be a marker of low BMD in suspected pHPT patients with a normal parathyroid hormone concentration. Purpose: To study if low BMD and osteoporosis are more common after ten years in patients with elevated compared with normal calcium concentrations at baseline. Subjects: One hundred twenty-seven patients (28 men) with baseline elevated, and 254 patients (56 men) with baseline normal calcium concentrations, mean age 61 years, were recruited. After ten years, 77% of those still alive (74 with elevated and 154 with normal calcium concentrations at baseline) participated in a dual energy x-ray absorptiometry measurement for BMD assessment and analysis of calcium and parathyroid hormone concentrations. Main outcome measures: Association between elevated and normal calcium concentration at base-line and BMD at follow-up. Correlation between calcium and parathyroid hormone concentrations and BMD at follow-up. Results: A larger proportion of the patients with elevated baseline calcium concentrations who participated in the follow-up had osteoporosis (p value - 0.036), compared with the patients with normal concentrations. In contrast, no correlation was found between calcium or parathyroid hormone concentrations and BMD at follow-up. Conclusions: In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%), which highlights the importance of examining these patients further using absorptiometry, even when their parathyroid hormone level is normal.

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