Effect of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women with Mild Primary Hyperparathyroidism

Grey, Andrew; Stapleton, Joanne P.; Evans, Margaret C.; Tatnell, Michele A.; Reid, Ian R.

doi:10.7326/0003-4819-125-5-199609010-00002

Cited by 163 publications

(109 citation statements)

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“…Alkaline phosphatase activity decreased by 22%, urinary hydroxyproline excretion by 38%, N-telopeptide excretion decreased by 60% and urinary calcium excretion by 33% at the end of the study (144). Likewise, there were significant increases in total body, lumbar spine, femur neck and forearm BMD (144) (A-1B).…”

Section: Hormone Replacement Therapymentioning

confidence: 83%

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Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira

Griz

Chaves

et al. 2013

Arq Bras Endocrinol Metab

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Objective: To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. Materials and methods: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D" , are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. Conclusion:We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment. Arq Bras Endocrinol Metab. 2013;57(6):406-24 KeywordsPrimary hyperparathyroidism; normocalcemic primary hyperparathyroidism; diagnosis; treatment; parathyroidectomy ReSumoObjetivo: Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, do diagnóstico e do manejo clínico e cirúrgico do hiperparatireoidismo primário clássico e normocalcêmico. Materiais e métodos: Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB) da SBEM. Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, da Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos, e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do "Oxford Centre for Evidence-based Medicine" . Todos os graus de recomendação, incluindo-se o "D" , foram baseados em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. Conclusão: Apresentamos uma atualização científica a respeito do hiperparatireoidismo primário, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento. Arq Bras Endocrinol Metab. 2013;57(6):406-24 Descritores Hiperparatireoidismo primário; hiperparatireoidismo primário normocalcêmico; diagnóstico; tratamento; paratireoidectomia

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Section: Hormone Replacement Therapymentioning

confidence: 83%

“…Most of the bone loss occurred after the first 8 years of follow-up. Most studies (135,(138)(139)(140)(141)(142)(143), but not all (143,144) do not show reduction in BMD at any sites during the first years of observation without intervention (B-2B).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira

Griz

Chaves

et al. 2013

Arq Bras Endocrinol Metab

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show abstract

“…These effects would be expected to increase the BMD. Oestrogen therapy was found to increase the femoral neck and the lumbar spine BMD in postmenopausal women with PHPT without affecting ionised calcium and PTH levels (71). Oestrogen therapy for a limited length of time can be a reasonable option in early postmenopausal women with mild PHPT and low BMD, who have no contraindications for the use of oestrogens, Table 3.…”

Section: Antiresorptive Therapymentioning

confidence: 99%

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Bollerslev

Marcocci

Sosa

et al. 2011

European Journal of Endocrinology

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Management of patients with mild primary hyperparathyroidism (PHPT) has been widely discussed because most patients today do not have specific symptoms. While surgery is always an option, the recommendations for treatment have shifted, which mostly reflects changes in clinical practice. In this study, we aimed to evaluate evidence for the current recommendations concerning operation vs observation, repletion with vitamin D (VitD) and alternative medical management.Surgery is followed by normalisation of calcium and parathyroid hormone (PTH) and a decrease in bone turnover followed by an increase in bone mass. It is not known what the consequences would be for the frequency of fractures. Randomised studies have indicated beneficial effects of operation on quality of life (QoL), but the effects have been minor and inconsistent. Operation seems not to be superior to observation for cardiovascular risk factors. Although PHPT patients in average have slightly decreased plasma 25OH VitD, severe symptomatic VitD deficiency seems not to be a characteristic of PHPT patients in Europe. However, if present, we recommend VitD substitution before final decision on surgical treatment. It is unknown whether routine VitD supplementation should be offered preoperatively to all patients with mild PHPT or as part of long-term medical treatment.Targeted medical management could be an option for patients with contraindications to surgery. Antiresorptive therapy might be appropriate for patients with a low bone mass to prevent further bone loss. Calcimimetics could be tried to control serum calcium levels although there is no evidence of an effect on the hypercalcaemic symptoms or the QoL. Combined therapy with calcimimetics and alendronate could be considered for patients with hypercalcaemia and overt bone disease.

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“…The use of oral phosphate has been limited by its lack of efficacy, risk of metastatic calcification and gastrointestinal intolerance (47). Oestrogen therapy reduces PTH-mediated bone resorption (49,50), but it is not a treatment option in older women because of its side effects and because it has little effect on serum levels of calcium and PTH. There are no data on the effectiveness of selective oestrogen receptor modulators (such as raloxifene) on serum calcium or PTH levels in this disorder.…”

Section: Management Of Primary Hyperparathyroidism -Medical Treatmentmentioning

confidence: 99%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

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As more and more cases of primary hyperparathyroidism are being detected by screening for serum calcium concentration, the majority of patients are older individuals who are asymptomatic or have symptoms which are difficult to ascribe to hyperparathyroidism. Long-term follow-up has provided evidence that most asymptomatic patients who do not undergo parathyroidectomy will not develop symptomatic complications. Some asymptomatic patients, however, have progression of disease over time. These observations and the lack of reliable predictors of the rate of progression in most patients reinforce the need for careful monitoring in elderly individuals who do not undergo surgery. Biannual measurements of serum calcium concentrations and annual measurements of urinary calcium excretion and bone mineral density should be performed in all patients who are managed conservatively. In elderly patients with symptomatic or complicated primary hyperparathyroidism, parathyroidectomy results in biochemical cure and increased bone density, both at the lumbar spine and the femoral neck, and should be considered. Criteria for surgery include significant hypercalcemia (.1 mg/dl above the upper limit of normal), marked hypercalciuria (. 400 mg per day), low bone density, unexplained renal insufficiency and an episode of acute primary hyperparathyroidism. Consideration of parathyroidectomy should also be given to elderly patients with primary hyperparathyroidism who are vitamin D deficient. Radionuclide scanning has become the initial non-invasive study of choice when parathyroid gland localization is necessary before parathyroidectomy; this is generally for fragile patients and reoperative cases. In a subset of older individuals, surgery may not be an option because of coexisting medical problems even though surgical indications are present.European Journal of Endocrinology 151 297-304

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Effect of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women with Mild Primary Hyperparathyroidism

Cited by 163 publications

References 0 publications

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Primary hyperparathyroidism: diagnosis and management in the older individual

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