Bone Mineral Density Changes in Multiple Endocrine Neoplasia Type ۱: A Systematic Review and Meta-Analysis of Prevalence and Parathyroidectomy Outcomes

Objectives: This study aimed to analyze the prevalence of osteopenia and osteoporosis in MEN۱-related primary hyperparathyroidism (PHPT), examine the impact of parathyroidectomy (PTX) on bone metabolic outcomes, and compare bone density metrics between sporadic and MEN۱-related PHPT. Methods: A systematic review and meta-analysis were conducted in accordance with the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). We searched PubMed, Web of Science, and Scopus up to June ۲۰۲۴, subsequently screening the articles to identify relevant research. Studies focusing on bone mineral density (BMD), T and Z-scores in patients with MEN۱-related conditions were included. Meta-analyses were conducted using random-effects models. Results: From the initial ۲,۵۶۳ articles, ۱۵ studies were included in the meta-analysis. The pooled prevalence of osteoporosis and osteopenia in patients with MEN۱-related PHPT was ۴۵.۲% (۹۵% CI: ۳۹.۱-۵۱.۴%; I۲: ۱۶.۷%) and ۵۳.۳% (۹۵% CI: ۴۴.۴-۶۲.۰%; I۲: ۳۶.۱۵%), respectively. PTX showed no significant impact on BMD in MEN۱-related PHPT patients at the lumbar spine (mean difference: -۰.۰۵۴; P-value = ۰.۰۹۲; I۲: ۰.۸۶%) or femoral neck (mean difference: -۰.۰۲۵; P-value = ۰.۲۱۹; I۲: ۰.۴۷%). Comparisons of bone density metrics showed that MEN۱-related PHPT patients had significantly lower Z-scores at the lumbar spine (mean difference: -۰.۶۷۶; P-value < ۰.۰۰۱; I۲: ۴۱.۸۶%), total hip (mean difference: -۰.۶۲۹; P < ۰.۰۰۱; I۲: ۲۳.۴%), and femoral neck (mean difference: -۰.۵۱۶; P < ۰.۰۰۱; I۲ = ۳۸.۸۲%) compared to patients with sporadic PHPT. Conclusion: Patients with MEN۱-related PHPT exhibited a high prevalence of osteopenia and osteoporosis, along with lower BMD metrics compared to those with sporadic PHPT. PTX was not associated with significant changes in BMD among MEN۱-related PHPT patients.         Level of evidence: V Objectives: This study aimed to analyze the prevalence of osteopenia and osteoporosis in MEN۱-related primary hyperparathyroidism (PHPT), examine the impact of parathyroidectomy (PTX) on bone metabolic outcomes, and compare bone density metrics between sporadic and MEN۱-related PHPT. Methods: A systematic review and meta-analysis were conducted in accordance with the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). We searched PubMed, Web of Science, and Scopus up to June ۲۰۲۴, subsequently screening the articles to identify relevant research. Studies focusing on bone mineral density (BMD), T and Z-scores in patients with MEN۱-related conditions were included. Meta-analyses were conducted using random-effects models. Results: From the initial ۲,۵۶۳ articles, ۱۵ studies were included in the meta-analysis. The pooled prevalence of osteoporosis and osteopenia in patients with MEN۱-related PHPT was ۴۵.۲% (۹۵% CI: ۳۹.۱-۵۱.۴%; I۲: ۱۶.۷%) and ۵۳.۳% (۹۵% CI: ۴۴.۴-۶۲.۰%; I۲: ۳۶.۱۵%), respectively. PTX showed no significant impact on BMD in MEN۱-related PHPT patients at the lumbar spine (mean difference: -۰.۰۵۴; P-value = ۰.۰۹۲; I۲: ۰.۸۶%) or femoral neck (mean difference: -۰.۰۲۵; P-value = ۰.۲۱۹; I۲: ۰.۴۷%). Comparisons of bone density metrics showed that MEN۱-related PHPT patients had significantly lower Z-scores at the lumbar spine (mean difference: -۰.۶۷۶; P-value < ۰.۰۰۱; I۲: ۴۱.۸۶%), total hip (mean difference: -۰.۶۲۹; P < ۰.۰۰۱; I۲: ۲۳.۴%), and femoral neck (mean difference: -۰.۵۱۶; P < ۰.۰۰۱; I۲ = ۳۸.۸۲%) compared to patients with sporadic PHPT. Conclusion: Patients with MEN۱-related PHPT exhibited a high prevalence of osteopenia and osteoporosis, along with lower BMD metrics compared to those with sporadic PHPT. PTX was not associated with significant changes in BMD among MEN۱-related PHPT patients.         Level of evidence: V

کلیدواژه ها:

Bone mineral density ، Meta-analysis ، Multiple Endocrine Neoplasia ، Primary Hyperparathyroidism