{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:48:43Z","timestamp":1791676123254,"version":"4.3.4"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rev Endocr Metab Disord"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic hypoparathyroidism (HypoPT) is characterized by sustained parathyroid hormone (PTH) deficiency, leading to reduced bone turnover, increased bone mineral density (BMD), and altered skeletal microarchitecture. Despite preserved or elevated BMD, fracture risk in HypoPT remains controversial. We conducted a systematic review and meta-analysis to assess site-specific fracture risk and the influence of disease duration in patients with chronic HypoPT. Fifteen observational studies, including 13,563 HypoPT subjects and 137,245 controls, were analyzed. HypoPT subjects had a significantly higher risk of vertebral fractures (VFs) than controls (OR 1.88, 95% CI 1.23\u20132.88), with the excess risk confined to individuals with non-surgical disease (OR 3.05, 95% CI 1.68\u20135.54). No significant difference between HypoPT and controls were observed in non-vertebral (OR 1.01 (95% CI 0.83, 1.22) or hip fractures (OR 0.81, 95% CI 0.63\u20131.04). Meta-regression analyses demonstrated that longer median disease duration was associated with higher fracture prevalence at non-vertebral and hip sites. These findings support a site-specific pattern of skeletal fragility, characterized by increased vertebral vulnerability, particularly in non-surgical HypoPT, alongside relative protection at cortical-predominant sites. Fracture risk in HypoPT appears to evolve over time and to become evident during long-term follow-up. Longitudinal, site-directed fracture assessment should be considered in clinical practice.<\/jats:p>","DOI":"10.1007\/s11154-026-10051-8","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T03:51:10Z","timestamp":1778471470000},"page":"837-852","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Site-specific fracture risk in chronic hypoparathyroidism: systematic review and meta-analysis"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1143-4926","authenticated-orcid":false,"given":"Andrea","family":"Palermo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5829-9820","authenticated-orcid":false,"given":"Eleonora","family":"Sargentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6105-8212","authenticated-orcid":false,"given":"Roberto","family":"Cesareo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6808-0700","authenticated-orcid":false,"given":"Gaia","family":"Tabacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-3381","authenticated-orcid":false,"given":"Anda Mihaela","family":"Naciu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-4937","authenticated-orcid":false,"given":"Pierpaolo","family":"Trimboli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"4","key":"10051_CR1","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1210\/endrev\/bnaf010","volume":"46","author":"A Roumpou","year":"2025","unstructured":"Roumpou A, et al. Bone in parathyroid diseases revisited: evidence from epidemiological, surgical and new drug outcomes. Endocr Rev. 2025;46(4):576\u2013620.","journal-title":"Endocr Rev"},{"issue":"11","key":"10051_CR2","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1002\/jbmr.2273","volume":"29","author":"L Underbjerg","year":"2014","unstructured":"Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical hypoparathyroidism\u2014risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res. 2014;29(11):2504\u201310.","journal-title":"J Bone Miner Res"},{"key":"10051_CR3","doi-asserted-by":"crossref","unstructured":"Mendon\u00e7a ML, et al. Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord. 2013;13.","DOI":"10.1186\/1472-6823-13-1"},{"issue":"5","key":"10051_CR4","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1210\/clinem\/dgab076","volume":"106","author":"C Cipriani","year":"2021","unstructured":"Cipriani C, et al. Vertebral fracture assessment in postmenopausal women with postsurgical hypoparathyroidism. J Clin Endocrinol Metab. 2021;106(5):1303\u201311.","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"10051_CR5","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1007\/s40618-022-01818-2","volume":"45","author":"S Saha","year":"2022","unstructured":"Saha S, Mannar V, Kandasamy D, Sreenivas V, Goswami R. Vertebral fractures, trabecular bone score and their determinants in chronic hypoparathyroidism. J Endocrinol Invest. 2022;45(9):1777\u201386.","journal-title":"J Endocrinol Invest"},{"issue":"9","key":"10051_CR6","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1002\/jbmr.2501","volume":"30","author":"L Underbjerg","year":"2015","unstructured":"Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res. 2015;30(9):1738\u201344.","journal-title":"J Bone Miner Res"},{"issue":"11","key":"10051_CR7","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1007\/s00198-021-05966-8","volume":"32","author":"R Pal","year":"2021","unstructured":"Pal R, Bhadada SK, Mukherjee S, Banerjee M, Kumar A. Fracture risk in hypoparathyroidism: a systematic review and meta-analysis. Osteoporos Int. 2021;32(11):2145\u201353.","journal-title":"Osteoporos Int"},{"issue":"9","key":"10051_CR8","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1002\/jbmr.4871","volume":"38","author":"SH Ahn","year":"2023","unstructured":"Ahn SH, et al. Risk of fractures in thyroid cancer patients with postoperative hypoparathyroidism: a nationwide cohort study in Korea. J Bone Miner Res. 2023;38(9):1268\u201377.","journal-title":"J Bone Miner Res"},{"issue":"1","key":"10051_CR9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1093\/ejendo\/lvaf128","volume":"193","author":"EJ Ku","year":"2025","unstructured":"Ku EJ, et al. Osteoporotic fracture risk in hypoparathyroidism following total thyroidectomy: a retrospective nationwide cohort study. Eur J Endocrinol. 2025;193(1):39\u201347.","journal-title":"Eur J Endocrinol"},{"issue":"7","key":"10051_CR10","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1093\/jbmr\/zjaf061","volume":"40","author":"S Bj\u00f6rnsdottir","year":"2025","unstructured":"Bj\u00f6rnsdottir S, et al. Increased risk of vertebral fractures and reduced risk of femur fractures in patients with chronic hypoparathyroidism: a nationwide cohort study in Sweden. J Bone Miner Res. 2025;40(7):860\u20137.","journal-title":"J Bone Miner Res"},{"key":"10051_CR11","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"issue":"2","key":"10051_CR12","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/cen.13895","volume":"90","author":"T Vadiveloo","year":"2019","unstructured":"Vadiveloo T, Donnan PT, Leese CJ, Abraham KJ, Leese GP. Increased mortality and morbidity in patients with chronic hypoparathyroidism: a population\u2010based study. Clin Endocrinol (Oxf). 2019;90(2):285\u201392.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"3","key":"10051_CR13","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1007\/s40618-023-02177-2","volume":"47","author":"I Slutzky-Shraga","year":"2024","unstructured":"Slutzky-Shraga I, et al. Features of patients and fracture risk in hypoparathyroidism; a single center study. J Endocrinol Invest. 2024;47(3):593\u2013601.","journal-title":"J Endocrinol Invest"},{"issue":"5","key":"10051_CR14","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.surg.2021.05.004","volume":"170","author":"DTW Lui","year":"2021","unstructured":"Lui DTW, Fung MMH, Lee CH, Fong CHY, Woo YC, Lang BHH. A territory-wide assessment of the incidence of persistent hypoparathyroidism after elective thyroid surgery and its impact on new fracture risk over time. Surgery. 2021;170(5):1369\u201375.","journal-title":"Surgery"},{"issue":"5","key":"10051_CR15","doi-asserted-by":"publisher","first-page":"e0232842","DOI":"10.1371\/journal.pone.0232842","volume":"15","author":"SH Kim","year":"2020","unstructured":"Kim SH, et al. Prevalence and complications of nonsurgical hypoparathyroidism in Korea: a nationwide cohort study. PLoS ONE. 2020;15(5):e0232842.","journal-title":"PLoS ONE"},{"key":"10051_CR16","doi-asserted-by":"publisher","first-page":"100258","DOI":"10.1016\/j.endmts.2025.100258","volume":"19","author":"NL Reddy","year":"2025","unstructured":"Reddy NL, et al. Estimating complications and mortality in patients with post-surgical chronic hypoparathyroidism in England: A retrospective matched cohort study. Endocr Metab Sci. 2025;19:100258.","journal-title":"Endocr Metab Sci"},{"key":"10051_CR17","doi-asserted-by":"crossref","unstructured":"Chawla H, Saha S, Kandaswamy D, Sharma R, Sreenivas V, Goswami R. Vertebral fractures and bone mineral density in patients with idiopathic hypoparathyroidism on long term follow-up. J Clin Endocrinol Metab. 2016:jc.2016\u20133292.","DOI":"10.1210\/jc.2016-3292"},{"key":"10051_CR18","doi-asserted-by":"publisher","first-page":"948435","DOI":"10.3389\/fendo.2022.948435","volume":"13","author":"CB d\u2019 Alva","year":"2022","unstructured":"d\u2019Alva CB, et al. Morphometric vertebral fracture risk in women with postsurgical hypoparathyroidism. Front Endocrinol (Lausanne). 2022;13:948435.","journal-title":"Front Endocrinol (Lausanne)"},{"key":"10051_CR19","doi-asserted-by":"crossref","unstructured":"Tournis S, et al. Approach to the patient: management of bone fragility in patients with chronic hypoparathyroidism. J Clin Endocrinol Metab. 2026.","DOI":"10.1210\/clinem\/dgag160"}],"container-title":["Reviews in Endocrine and Metabolic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-026-10051-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11154-026-10051-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11154-026-10051-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:06:09Z","timestamp":1791673569000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11154-026-10051-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10051"],"URL":"https:\/\/doi.org\/10.1007\/s11154-026-10051-8","relation":{},"ISSN":["1389-9155","1573-2606"],"issn-type":[{"value":"1389-9155","type":"print"},{"value":"1573-2606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"assertion":[{"value":"13 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article was originally published under the subscription model but it is now published under an Open Access license.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Being a systematic review, ethical committee approval was not required.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}