{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T01:26:43Z","timestamp":1783042003884,"version":"3.54.6"},"reference-count":23,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"European Union of Medical Specialists"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>In primary hyperparathyroidism (PHPT) bone mineral density (BMD) is typically decreased in cortical bone and relatively preserved in trabecular bone. An increased fracture rate is observed however not only at peripheral sites but also at the spine, and fractures occur at higher BMD values than expected. We hypothesized that components of bone quality other than BMD are affected in PHPT as well.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate bone material properties using impact microindentation (IMI) in PHPT patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this cross-sectional study, the Bone Material Strength index (BMSi) was measured by IMI at the midshaft of the tibia in 37 patients with PHPT (28 women), 11 of whom had prevalent fragility fractures, and 37 euparathyroid controls (28 women) matched for age, gender, and fragility fracture status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean age of PHPT patients and controls was 61.8\u2005\u00b1\u200513.3 and 61.0\u2005\u00b1\u200511.8 years, respectively, P\u2005=\u2005.77. Calcium and PTH levels were significantly higher in PHPT patients but BMD at the lumbar spine (0.92\u2005\u00b1\u20050.15 vs 0.89\u2005\u00b1\u20050.11, P\u2005=\u2005.37) and the femoral neck (0.70\u2005\u00b1\u20050.11 vs 0.67\u2005\u00b1\u20050.07, P\u2005=\u2005.15) were comparable between groups. BMSi however was significantly lower in PHPT patients than in controls (78.2\u2005\u00b1\u20055.7 vs 82.8\u2005\u00b1\u20054.5, P\u2005&amp;lt;\u2005.001). In addition, BMSi was significantly lower in 11 PHPT patients with fragility fractures than in the 26 PHPT patients without fragility fractures (74.7\u2005\u00b1\u20056.0 vs 79.6\u2005\u00b1\u20055.0, P\u2005=\u2005.015).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our data indicate that bone material properties are altered in PHPT patients and most affected in those with prevalent fractures. IMI might be a valuable additional tool in the evaluation of bone fragility in patients with PHPT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab207","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T18:46:11Z","timestamp":1617043571000},"page":"e2527-e2534","source":"Crossref","is-referenced-by-count":13,"title":["Bone Material Strength Index as Measured by Impact Microindentation is Low in Patients with Primary Hyperparathyroidism"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2646-7488","authenticated-orcid":false,"given":"Manuela","family":"Schoeb","sequence":"first","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-1588","authenticated-orcid":false,"given":"Elizabeth M","family":"Winter","sequence":"additional","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A","family":"Sleddering","sequence":"additional","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam A","family":"Lips","sequence":"additional","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbey","family":"Schepers","sequence":"additional","affiliation":[{"name":"Center for Bone Quality and Center for Endocrine Tumors, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Snel","sequence":"additional","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5035-127X","authenticated-orcid":false,"given":"Natasha M","family":"Appelman-Dijkstra","sequence":"additional","affiliation":[{"name":"Center for Bone Quality, Department of Internal Medicine and division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"issue":"1","key":"2021122203543183300_CIT0001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00198-016-3716-2","article-title":"Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus","volume":"28","author":"Khan","year":"2017","journal-title":"Osteoporos Int."},{"key":"2021122203543183300_CIT0002","doi-asserted-by":"crossref","first-page":"16033","DOI":"10.1038\/nrdp.2016.33","article-title":"Primary hyperparathyroidism","volume":"2","author":"Bilezikian","year":"2016","journal-title":"Nat Rev Dis Primers."},{"issue":"3","key":"2021122203543183300_CIT0003","doi-asserted-by":"crossref","first-page":"P1","DOI":"10.1530\/EJE-19-0316","article-title":"MANAGEMENT OF ENDOCRINE DISEASE: Unmet therapeutic, educational and scientific needs in parathyroid disorders","volume":"181","author":"Bollerslev","year":"2019","journal-title":"Eur J Endocrinol."},{"issue":"9","key":"2021122203543183300_CIT0004","doi-asserted-by":"crossref","first-page":"3462","DOI":"10.1210\/jc.2007-1215","article-title":"The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years","volume":"93","author":"Rubin","year":"2008","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"2021122203543183300_CIT0005","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1002\/jbmr.1841","article-title":"Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women","volume":"28","author":"Stein","year":"2013","journal-title":"J Bone Miner Res."},{"key":"2021122203543183300_CIT0006","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3389\/fendo.2020.00015","article-title":"Added value of impact microindentation in the evaluation of bone fragility: a systematic review of the literature","volume":"11","author":"Schoeb","year":"2020","journal-title":"Front Endocrinol (Lausanne)."},{"issue":"5","key":"2021122203543183300_CIT0007","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1210\/jc.2014-4346","article-title":"Bone material strength as measured by microindentation in vivo is decreased in patients with fragility fractures independently of bone mineral density","volume":"100","author":"Malgo","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"issue":"8","key":"2021122203543183300_CIT0008","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1007\/s00198-017-4054-8","article-title":"Bone material strength index as measured by impact microindentation is low in patients with fractures irrespective of fracture site","volume":"28","author":"Malgo","year":"2017","journal-title":"Osteoporos Int."},{"issue":"1","key":"2021122203543183300_CIT0009","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s00223-017-0256-5","article-title":"Reduced bone material strength is associated with increased risk and severity of osteoporotic fractures. an impact microindentation study","volume":"101","author":"Sosa","year":"2017","journal-title":"Calcif Tissue Int."},{"issue":"9","key":"2021122203543183300_CIT0010","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1210\/en.2019-00415","article-title":"Associations between bone impact microindentation and clinical risk factors for fracture","volume":"160","author":"Rufus-Membere","year":"2019","journal-title":"Endocrinology."},{"key":"2021122203543183300_CIT0011","doi-asserted-by":"crossref","first-page":"115110","DOI":"10.1016\/j.bone.2019.115110","article-title":"Impact microindentation assesses subperiosteal bone material properties in humans","volume":"131","author":"Rokidi","year":"2020","journal-title":"Bone."},{"key":"2021122203543183300_CIT0012","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bonr.2016.07.004","article-title":"Technical note: Recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation","volume":"5","author":"Diez-Perez","year":"2016","journal-title":"Bone Rep."},{"issue":"3","key":"2021122203543183300_CIT0013","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00198-011-1852-2","article-title":"Calibration of FRAX (R) 3.1 to the Dutch population with data on the epidemiology of hip fractures","volume":"23","author":"Lalmohamed","year":"2012","journal-title":"Osteoporos Int."},{"issue":"9","key":"2021122203543183300_CIT0014","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/jbmr.5650080915","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant","year":"1993","journal-title":"J Bone Miner Res."},{"issue":"9","key":"2021122203543183300_CIT0015","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1007\/s00198-020-05375-3","article-title":"Treatments of osteoporosis increase bone material strength index in patients with low bone mass","volume":"31","author":"Schoeb","year":"2020","journal-title":"Osteoporos Int."},{"key":"2021122203543183300_CIT0016","author":"Schoeb","year":"2021"},{"issue":"9","key":"2021122203543183300_CIT0017","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1002\/jbmr.3461","article-title":"Prevalence and risk of vertebral fractures in primary hyperparathyroidism: a nested case-control study","volume":"33","author":"Ejlsmark-Svensson","year":"2018","journal-title":"J Bone Miner Res."},{"issue":"2","key":"2021122203543183300_CIT0018","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00198-019-05177-2","article-title":"PTH and bone material strength in hypoparathyroidism as measured by impact microindentation","volume":"31","author":"Starr","year":"2020","journal-title":"Osteoporos Int"},{"issue":"4","key":"2021122203543183300_CIT0019","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/jbmr.3338","article-title":"Bone material strength index as measured by impact microindentation in postmenopausal women with distal radius and hip fractures","volume":"33","author":"Rozental","year":"2018","journal-title":"J Bone Miner Res."},{"issue":"2","key":"2021122203543183300_CIT0020","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00198-019-05177-2","article-title":"PTH and bone material strength in hypoparathyroidism as measured by impact microindentation","volume":"31","author":"Starr","year":"2020","journal-title":"Osteoporos Int."},{"issue":"8","key":"2021122203543183300_CIT0021","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for prevention of fractures in postmenopausal women with osteoporosis","volume":"361","author":"Cummings","year":"2009","journal-title":"N Engl J Med."},{"key":"2021122203543183300_CIT0022","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1016\/j.amjmed.2008.12.003","article-title":"Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis","volume":"122","author":"Bilezikian","year":"2009","journal-title":"Am J Med."},{"issue":"18","key":"2021122203543183300_CIT0023","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1056\/NEJMoa1204061","article-title":"Fracture risk and zoledronic acid therapy in men with osteoporosis","volume":"367","author":"Boonen","year":"2012","journal-title":"N Engl J Med."}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgab207\/37951306\/dgab207.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/7\/e2527\/41849112\/dgab207.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/7\/e2527\/41849112\/dgab207.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T03:56:24Z","timestamp":1640145384000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/106\/7\/e2527\/6199856"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,29]]},"references-count":23,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,3,29]]},"published-print":{"date-parts":[[2021,6,16]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgab207","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,7,1]]},"published":{"date-parts":[[2021,3,29]]}}}