Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study)

Lundstam, Karolina; Heck, Ansgar; Godang, Kristin; Mollerup, Charlotte; Baranowski, M; Pernow, Ylva; Aas, Turid; Hessman, Ola; Rosén, Thord; Nordenström, Jörgen; Jansson, Svante; Hellström, Mikael; Bollerslev, Jens

doi:10.1002/jbmr.3177

Cited by 72 publications

(60 citation statements)

References 40 publications

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“…Multiple studies have reported increases in BMD after PTX, but only 3 have categorized results by gender while focusing on bone disease Of these three, Sharma et al and Ballem et al found a greater post‐PTX improvement in BMD in men than in women, while Dy et al determined that the extent of bone recovery after PTX was not affected by gender or menopausal status. The use of bisphosphonate, longer time for postoperative DXA scan (within 3 years of surgical intervention), and exclusive analysis at the most affected anatomical site were unique characteristics to the study by Dy et al that differed from our study which might explain the different results.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have found that surgical intervention for sporadic PHPT (sPHPT) is associated with an increase in postoperative BMD, but only a few studies have examined gender differences in BMD improvement after PTX . In this retrospective study, we aimed to determine differences in laboratory data and BMD changes after PTX between men and women (both premenopausal [pre‐MP] and postmenopausal [post‐MP]) with sPHPT.…”

Section: Introductionmentioning

confidence: 99%

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Gender differences in bone mineral density in patients with sporadic primary hyperparathyroidism

Vodopivec

Silva

Garcia-Banigan

et al. 2018

Endocrino Diabet & Metabol

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Summary Context Primary hyperparathyroidism reduces bone mineral density, which increases the risk of fracture. Objective To investigate differences in bone mineral density and clinical characteristics after parathyroidectomy between men and women (premenopausal and postmenopausal) with sporadic primary hyperparathyroidism. Design This is a retrospective study of adult patients who underwent parathyroidectomy in a tertiary referral center from 1990 to 2013. Patients A total of 1529 patients underwent parathyroidectomy during the study period; 80 patients met the inclusion criteria. Of these, 24 were men and 56 were women (10 premenopausal and 46 postmenopausal). Measurements Demographics, preoperative and postoperative biochemical analysis, preoperative and postoperative T‐scores, preoperative Z‐scores, preoperative and postoperative absolute bone mineral density values, and percentage change in bone mineral density from baseline to 12 ± 6 months after parathyroidectomy in the lumbar spine, femoral neck, total hip and distal one‐third of the nondominant radius. Results Preoperative 24‐hour urinary calcium levels were significantly higher in men than in women overall (P = 0.02) and postmenopausal women (P = 0.01). Men had significantly lower preoperative Z‐scores than women overall, premenopausal women and postmenopausal women. Men had greater percentage change of increase in bone mineral density in the femoral neck than did women overall (2.77%; P = 0.04) and postmenopausal women (2.98%; P = 0.03) 1 year after parathyroidectomy. Conclusions From this study, men demonstrated a greater improvement of bone mineral density in the femoral neck from baseline after parathyroidectomy compared with women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gender differences in bone mineral density in patients with sporadic primary hyperparathyroidism

Vodopivec

Silva

Garcia-Banigan

et al. 2018

Endocrino Diabet & Metabol

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“…We initially identified 2219 potentially relevant articles, of which 51 were retrieved for detailed evaluation. Two RCTs from the same team or institution were included as they reported different outcomes [20,30]. One study not reporting essential information of outcomes was excluded [31].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…One study not reporting essential information of outcomes was excluded [31]. Finally, 5 RCTs with 584 patients [20,30,[32][33][34] and 10 CSs with 12202 patients [19,21,[35][36][37][38][39][40][41][42][43] were included (▶Fig. 1).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Long-Term Skeletal Outcomes of Primary Hyperparathyroidism Patients After Treatment with Parathyroidectomy: A Systematic Review and Meta-Analysis

Zhang

Liu

2018

Horm Metab Res

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The aim of the study was to assess and define the association between parathyroidectomy (PTX) and long-term skeletal outcomes in primary hyperparathyroidism (PHPT) patients. PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched up to June 31, 2017, without language restriction. Any study comparing skeletal outcomes [fracture risk or bone mineral density (BMD)] of PHPT patients after more than 12 months of PTX treatment versus non-PTX treatment was included. Pooled relative risks or odds ratios with 95% confidence intervals and weighted mean difference were calculated using random-effects models irrespective of statistical heterogeneity assessed by I statistic. Finally, 5 randomized controlled trials (RCTs, n=584) and 10 cohort studies (CSs, n=12202) were included. CSs suggest PTX treatment versus non-PTX treatment is significantly associated with 36% reduction in the risk of fracture, with no heterogeneity, and an increase in the lumbar spine change by 0.55 WMD, with no heterogeneity. RCTs indicate PTX treatment versus non-PTX treatment is significantly associated with BMD change of 0.97 WMD at the lumbar spine with substantial heterogeneity, and 1.23 WMD at the femoral neck with no heterogeneity. The existing CSs indicate PTX-treatment versus non-PTX-treatment might reduce the risk of fracture in PHPT patients. The existing RCTs do not provide sufficient or precise evidence that PTX-treatment affects the fracture risk of PHPT patients, but offer data that subsets of patients who could potentially benefit from PTX-treatment can be identified.

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“…Bone health is a clinical concern in PHPT patients, especially in those treated conservatively. Recent studies found a significant BMD decrease in patients treated conservatively and a significant positive BMD increase in patients who underwent PTX (6,7). High-resolution peripheral quantitative computed tomography (HRpQCT) analysis has shown improvement in bone microarchitecture, cortical thickness, density, and estimated strength following PTX in female PHPT patients (8).…”

Section: Introductionmentioning

confidence: 99%

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

Ohe

Bonansea

Santos³

et al. 2019

Archives of Endocrinology and Metabolism

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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.

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Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study)

Cited by 72 publications

References 40 publications

Gender differences in bone mineral density in patients with sporadic primary hyperparathyroidism

Gender differences in bone mineral density in patients with sporadic primary hyperparathyroidism

Long-Term Skeletal Outcomes of Primary Hyperparathyroidism Patients After Treatment with Parathyroidectomy: A Systematic Review and Meta-Analysis

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

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