Serum Periostin Levels are Significantly Higher in Patients with Primary Hyperparathyroidism and Closely Related to Osteoporosis

Abstract

Background Periostin is an emerging biomarker that plays a role in bone metabolism and may be associated with bone mineral density (BMD). This study is aimed to investigate serum periostin levels in patients with primary hyperparathyroidism (PHPT) and its correlation with BMD in these patients.

Methods Forty patients with newly diagnosed PHPT without co-morbidities and 30 healthy controls were included. Laboratory tests for the diagnosis of PHPT and serum levels of periostin were measured for all patients. BMD was measured on lumbar spines L1 and L4 by dual-energy X-ray absorptiometry (DEXA). Serum periostin levels were detected using an enzyme-linked immunosorbent assay (ELISA).

Results Serum periostin levels were significantly higher in patients with PHPT than in healthy controls (p<0.001). Serum periostin levels were also significantly higher (mean 59.7±11.0 ng/mL) in PHPT patients with osteoporosis than those without osteoporosis (p=0.004). In logistic regression analysis, only serum periostin levels independently predicted the patients with osteoporosis. According to this analysis, every 1 ng/mL increase in serum periostin increased the risk of having osteoporosis by 20.6%. When the cut-off for serum periostin level was 49.75 ng/mL, the patients with osteoporosis were predicted with 71.4% sensitivity and 69.2% specificity. Multivariate regression analysis revealed a negative correlation between serum periostin levels and L1-L4 T scores on DEXA.

Conclusion This is the first study to determine that serum periostin levels are higher in PHPT patients than those without PHPT and to demonstrate a significant association between serum periostin levels and T scores on DEXA in patients with PHPT. These findings will aid in detecting osteoporosis in patients with PHPT and making the decision for surgery in PHPT patients with no need for DEXA imaging that involves radiation.

Key words

primary hyperparathyroidism - periostin - osteoporosis - bone mineral density

Publication History

Received: 09 December 2022
Received: 02 March 2023

Accepted: 28 February 2023

Article published online:
05 June 2023

• References

• 1 Khundmiri SJ, Murray RD, Lederer E.. PTH and vitamin D. Compr Physiol 2016; 6: 561-601
• 2 Walker MD, Silverberg SJ.. Primary hyperparathyroidism. Nat Rev Endocrinol 2018; 14 (02) 115-125
• 3 Mazzuoli GF, D'Erasmo E, Pisani D.. Primary hyperparathyroidism and osteoporosis. Aging (Milano) 1998; 10: 225-231
• 4 Insogna KL.. Primary hyperparathyroidism. N Engl J Med 2018; 379: 1050-1059
• 5 Horiuchi K, Amizuka N, Takeshita S. et al. Identification and characterization of a novel protein, periostin, with restricted expression to periosteum and periodontal ligament and increased expression by transforming growth factor beta. J Bone Miner Res 1999; 14: 1239-1249
• 6 Bonnet N, Garnero P, Ferrari S.. Periostin action in bone. Mol Cell Endocrinol 2016; 432: 75-82
• 7 Idolazzi L, Ridolo E, Fassio A. et al. Periostin: The bone and beyond. Eur J Intern Med 2017; 38: 12-16
• 8 Fortunati D, Reppe S, Fjeldheim AK. et al. Periostin is a collagen associated bone matrix protein regulated by parathyroid hormone. Matrix Biol 2010; 29: 594-601
• 9 Rachner TD, Khosla S, Hofbauer LC.. Osteoporosis: Now and the future. Lancet 2011; 377: 1276-1287
• 10 Hekimsoy Z, Dinç G, Kafesçiler S. et al. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 2010; 10: 782 Published 2010 Dec 23
• 11 Cigerli O, Parildar H, Unal AD. et al. Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr 2013; 16: 1306-1313
• 12 Pepe J, Bonnet N, Cipriani C. et al. Higher serum levels of a cathepsin K-generated periostin fragment are associated with fractures in postmenopausal women with primary hyperparathyroidism: A pilot study. Osteoporos Int 2021; 32: 2365-2369
• 13 Rousseau JC, Sornay-Rendu E, Bertholon C. et al. Serum periostin is associated with fracture risk in postmenopausal women: A 7-year prospective analysis of the OFELY study. J Clin Endocrinol Metab 2014; 99: 2533-2539
• 14 Kim BJ, Rhee Y, Kim CH. et al. Plasma periostin associates significantly with non-vertebral but not vertebral fractures in postmenopausal women: Clinical evidence for the different effects of periostin depending on the skeletal site. Bone 2015; 81: 435-441
• 15 Guo YM, Cheng JH, Zhang H. et al. Serum periostin level and genetic polymorphisms are associated with vertebral fracture in Chinese postmenopausal women. Genes (Basel) 2022; 13: 439
• 16 Walsh JS, Gossiel F, Scott JR. et al. Effect of age and gender on serum periostin: Relationship to cortical measures, bone turnover and hormones. Bone 2017; 99: 8-13
• 17 Gerbaix M, Vico L, Ferrari SL. et al. Periostin expression contributes to cortical bone loss during unloading. Bone 2015; 71: 94-100
• 18 Garnero P.. The utility of biomarkers in osteoporosis management. Mol Diagn Ther 2017; 21: 401-418
• 19 Demirtas D, Acıbucu F, Baylan FA. et al. CTRP3 is significantly decreased in patients with primary hyperparathyroidism and closely related with osteoporosis. Exp Clin Endocrinol Diabetes 2020; 128: 152-157
• 20 Gulumsek E, Yesildal F, Koca H. et al. Native thiol decreases in patients with asymptomatic primary hyperparathyroidism, especially in the presence of surgery indication. Minerva Endocrinol (Torino) 2022; 10.23736/S2724-6507.22.03604-1