• Marija Punda, Petra Petranović Ovčariček, Anita Tabain, Klaas Pieter Koopmans, Gabriela Alfier, Tomislav Jukić, and Ana Fröbe.
• 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2University of Applied Health Sciences, Zagreb, Croatia; 3Department of Radiology and Nuclear Medicine, PET/CT Center, Medikol Polyclinic, Zagreb, Croatia; 4Department of Nuclear Medicine and Radiology, Martini Hospital, Groningen, The Netherlands; 5Department of Surgery, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
• Acta Clin Croat. 2021 Dec 1; 60 (4): 617-626.

AbstractThe bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.

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