Alendronate in the Treatment of Primary Hyperparathyroid-Related Osteoporosis: A 2-Year Study

Abstract

We investigated the effect of alendronate on calcium, PTH, and bone mineral density in 27 female and 5 male patients with primary hyperparathyroidism. The treatment group [n = 14; T score < or = -2.5 SD at the femoral neck (FN) or T < or = -1.0 SD plus previous nonvertebral fracture] was given alendronate 10 mg/d for 24 months. The second group (n = 18; T score > -2.5 SD at the FN) was untreated. Biochemistry was repeated at 1.5, 3, 6, 12, 18, and 24 months, and dual-energy x-ray absorptiometry at 12 and 24 months. There were no significant between-group baseline differences in calcium, creatinine, or PTH. Alendronate-treated patients gained bone at all sites [lumbar spine (LS), 1 yr gain, +7.3 +/- 1.7%; P < 0.001; 2 yr, +7.3 +/- 3.1%; P = 0.04). Untreated patients gained bone at the LS over 2 yr (+4.0 +/- 1.8%; P = 0.03) but lost bone elsewhere. Calcium fell nonsignificantly in the alendronate group between baseline (2.84 +/- 0.12 mmol/liter) and 6 wk (2.76 +/- 0.09 mmol/liter), with a nonsignificant rise in PTH (baseline, 103.5 +/- 14.6 ng/liter; 6 wk, 116.7 +/- 15.6 ng/liter). By 3 months, values had reverted to baseline. In primary hyperparathyroidism, alendronate is well tolerated and significantly improves bone mineral density at the LS (with lesser gains at FN and radius), especially within the first year of treatment. Short-term changes in calcium and PTH resolve by 3 months.

Bisphosphonate Therapy in Primary Hyperparathyroidism

“…(5) Another recently published study lacked a placebocontrolled group. (6) The two best-designed studies agree with the others that alendronate is associated with an increase in lumbar spine BMD within 1 year of therapy. Alendronate does not seem to alter significantly the serum calcium or parathyroid hormone concentration.…”

Effect of alendronate on bone metabolic indices and bone mineral density in patients treated with high-dose glucocorticoid: a prospective study

“…In most reports, the effects of aminobisphosphonates were evident in any age, across genders, and in patients with or without previous fractures [16][17][18]. Moreover, bisphosphonates were also effective in secondary osteoporosis, such as primary hyperparathyroidism, GIO, and hypogonadism [13,[19][20][21][22][23][24][25]. Alendronate is one of the first-line drugs for the preservation and treatment of GIO with extensive evidence [13,[19][20][21]25].…”

Medical treatment of hypercalcaemia

“…38 Alendronate has been more extensively studied and either a small effect on serum calcium 39,40 or no change at all have been reported. 41,42 Within a similar context, PTH was reported either to increase 39,42,43 or to remain unchanged. 40 A multicenter, double-blind, randomized, placebo-controlled study reported no effect of alendronate on either serum calcium or PTH levels.…”

“…The increase in bone mineral density has been a consistent finding of all studies using alendronate. [39][40][41] Similarly, risedronate reduced fasting serum calcium concentrations and biochemical markers of bone turnover in a small series of patients with primary HPT; additional studies are required to evaluate the long-term efficacy of this bisphosphonate in HPT. 37,45 The use of intravenous bisphosphonates (pamidronate, zoledronate) in primary HPT is restricted to the treatment of acute hypercalcaemia, 33 as it occurs, for example, in parathyroid crisis, which is associated with serum calcium concentrations greater than 15 mg/dl (3.75 mmol/l) and rapid deterioration of central nervous system, cardiac, gastrointestinal and renal function.…”