Prediction of bone mass changes after successful parathyroidectomy using biochemical markers of bone metabolism in primary hyperparathyroidism: is it clinically useful?

Abstract

Objective: To measure type 1 serum amino-terminal propeptide procollagen (P1NP) and type 1 cross-linked C-terminal telopeptide collagen (CTX) before parathyroidectomy (PTX) in PHPT patients, correlating these measurements with bone mineral density (BMD) changes. Subjects and methods: 31 primary hyperparathyroidism (HPTP) were followed from diagnosis up to 12-18 months after surgery. Serum levels of calcium, parathyroid hormone (PTH) vitamin D, CTX, P1NP, and BMD were measured before and 1 year after surgery. Results: One year after PTX, the mean BMD increased by 8.6%, 5.5%, 5.5%, and 2.2% in the lumbar spine, femoral neck (FN), total hip (TH), and distal third of the nondominant radius (R33%), respectively. There was a significant correlation between BMD change 1 year after the PTX and CTX (L1-L4: r = 0.614, p < 0.0003; FN: r = 0.497, p < 0.0051; TH: r = 0.595, p < 0.0005; R33%: r = 0.364, p < 0.043) and P1NP (L1-L4: r = 0,687, p < 0,0001; FN: r = 0,533, p < 0,0024; TH: r = 0,642, p < 0,0001; R33%: r = 0,467, p < 0,0079) preoperative levels. The increase in 25(OH)D levels has no correlation with BMD increase (r = -0.135; p = 0.4816). On linear regression, a minimum preoperative CTX value of 0.331 ng/mL or P1NP of 37.9 ng/mL was associated with a minimum 4% increase in L1-L4 BMD. In TH, minimum preoperative values of 0.684 ng/mL for CTX and 76.0 ng/ mL for P1NP were associated with a ≥ 4% increase in BMD. Conclusion: PHPT patients presented a significant correlation between preoperative levels of turnover markers and BMD improvement 1 year after PTX.

Identification of independent factors affecting bone mineral density after successful parathyroidectomy for symptomatic hyperparathyroidism

“…Consequently, it can be considered that patient characteristics did not have a significant effect on postoperative BMD improvement. Ohe et al recruited 31 patients with PHPT and found a significant association between the preoperative level of turnover markers and improvement in BMD 1 year after parathyroidectomy [18]. Therefore, these results suggest that the preoperative levels of turnover markers could be predictors of BMD improvement after parathyroidectomy.…”

Bone Turnover Markers: Basic Biology to Clinical Applications

“…This is believed to be the cause of the rapid improvement in BMD, especially at trabecular sites ( 373 ). Higher preoperative BTMs were found to be associated with greater BMD responses ( 374 , 375 ). BTMs decreased after surgery, independent of the presurgical use of bisphosphonates.…”

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

“…Abnormally high levels of bone turnover markers in PHPT patients indicate the potential bone loss and osteoporosis, which may further increase the risk of osteoporotic fractures. Furthermore, a retrospective study from Brazil demonstrated minimum preoperative values of 0.684 ng/mL for β-CTX and 76.0 ng/mL for P1NP in PHPT patients were associated with a ≥4% increase in BMD ( 30 ), making biochemical bone markers a surrogate tool to monitor the progression of PHPT.…”