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 1.23–2.88), with the excess risk confined to individuals with non-surgical disease (OR 3.05, 95% CI 1.68–5.54). 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 0.63–1.04). 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.

Background. Both primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) are associated with the onset and development of cardiovascular diseases (CVDs). Especially PHPT is accompanied by the presence of elevated atherothrombotic risk, while the importance of traditional and new anthropometric indices to reflect the cardiovascular risk remains uncertain in this condition. This study aims to investigate whether novel and traditional anthropometric indices distinguish PHPT and their correlation with atherothrombotic risk. Methods. 40 Subjects with HypoPT, 40 PHPT and 40 age- and sex-matched control subjects were consecutively enrolled for the evaluation of flow-mediated vasodilation (FMD) and carotid intimal-media thickness (IMT). A blood sample was collected for calcium-phosphate metabolism, PTH, TSH and 25-hydroxy vitamin D evaluation. Physical examination was performed to obtain traditional anthropometric parameters and derived indices of adiposity and cardiometabolic risk (waist height ratio (WHtR) and waist hip ratio (WHR) and conicity index (CI)). Results. The PHPT group showed higher central adiposity indices (WHtR p=0.002, and CI p=0.008). Among patients with parathyroid disorders, PHPT subjects display the highest reduction of FMD (p<0.001) and a marked increase of IMT (p0.05). Conclusions. WHtR and CI provide evidence of increased central fat adiposity in PHPT but do not account for impaired atherothrombotic risk, indicating that anthropometric indices may lack relevance to cardiovascular risk in this condition and emphasising the importance of a specific assessment profile.

Background: Both primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) are associated with the onset and development of cardiovascular diseases (CVDs). In particular, PHPT is accompanied by the presence of elevated atherothrombotic risk, while the importance of traditional and new anthropometric indices to reflect the cardiovascular risk remains uncertain in this condition. This study aims to investigate whether novel and traditional anthropometric indices distinguish PHPT and whether these indices are correlated with atherothrombotic risk. Methods: A total of 40 subjects with HypoPT, 40 with PHPT and 40 age- and sex-matched control subjects were consecutively enrolled for the evaluation of flow-mediated vasodilation (FMD) and carotid intima–media thickness (IMT). A blood sample was collected for evaluation of calcium–phosphate metabolism, PTH, TSH and 25-hydroxy vitamin D. Physical examination was performed to obtain traditional anthropometric parameters and derived indices of adiposity and cardiometabolic risk (waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and conicity index (CI)). Results: The PHPT group showed higher central adiposity indices (WHtR p = 0.002, and CI p = 0.008). Among patients with parathyroid disorders, PHPT subjects displayed the highest reduction in FMD (p < 0.001) and a marked increase in IMT (p < 0.001). In the Ctrl group, WHtR showed a weak-to-moderate positive association with IMT (r = 0.381, p = 0.018). In the PHPT group, no anthropometric index was significantly correlated with IMT or FMD (all p > 0.05). Conclusions: WHtR and CI provide evidence of increased central fat adiposity in PHPT but do not account for impaired atherothrombotic risk, indicating that anthropometric indices may lack relevance to cardiovascular risk in this condition and emphasizing the importance of a specific assessment profile.