Evaluation of Changes in Bone Density and Biochemical Parameters after Parathyroidectomy in Primary Hyperparathyroidism.

Abstract

Abstract.We examined the relationships between serum levels of intact parathyroid hormone (PTH) and alkaline phosphatase (ALP) versus bone mineral density (BMD) at the lumbar spine and radius in terms of their preoperative values and of their annual percentage and net changes after parathyroidectomy (PTX) in 44 Japanese patients (14 men and 30 women) with primary hyperparathyroidism (pHPT). Lumbar and radial BMD values were measured by dual energy X-ray absorptiometry and single photon absorptiometry and were used for evaluating the cancellous and cortical bone mass, respectively.Age-and sex-adjusted value (Z-score) of the radial BMD was significantly lower than that of the lumbar BMD before and after PTX (P<0.05).In preoperative patients, serum levels of both intact PTH and ALP were significantly and negatively correlated with Z-score of the radial BMD (P<0.05 and P<0.001, respectively), but not with that of the lumbar BMD. After PTX, serum levels of calcium, phosphorus, ALP, and PTH became normal, and both lumbar and radial BMD values markedly increased over 1 year, with percentage changes of 12.2± 1.4% and 11.6± 1.6%, respectively, which were larger than those in any other Caucasian study previously documented.Even in patients without osteopenia (Z-score of BMD >_ 0), lumbar and radial BMD values increased considerably after the operation (9.6± 1.9% and 6.7± 1.4%, respectively).Annual percentage and net changes in lumbar BMD were significantly and negatively correlated with those in ALP with high correlation coefficients, but those in radial BMD were correlated only with the annual net change in ALP but not with the percentage change. No significant correlations were observed between annual changes in either lumbar or radial BMD and those in intact PTH. Taken together, this study shows that PTX causes dramatic improvements in both the cancellous and cortical bone mass in Japanese pHPT patients regardless of the severity of their osteopenia, and suggests that the cancellous and cortical bones react differently to a preoperative endogenous PTH excess and a high bone turnover rate as well as to the postoperative normalization of a bone turnover rate in the patients. The cortical and cancellous bones also seem to react differently to the normalization of a high circulating level of PTH and of a high bone turnover rate which occurred after parathyroidectomy (PTX) in pHPT patients.Bone mineral density (BMD) has been reported to increase after PTX in Caucasian pHPT patients [11][12][13][14][15][16], and two studies have shown that the percentage increase in BMD of the lumbar spine after PTX was greater than that in BMD of the radius [16,17] . However, such clinical studies have yet to be performed in Japanese pHPT patients, and thus it remains unclear whether or not PTX has a similar beneficial effect on bone mass, or whether or not the recovery of bone loss after PTX is different between the cortical and cancellous bones in Japanese patients.In the present study, we assessed the cortical and cancellous bone mass in...

Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; a six‐year longitudinal study with or without parathyroidectomy in a Japanese population

“…Intact PTH was negatively and significantly correlated with the baseline z-score of radial BMD ( r = − 0·282, P = 0·015), but not with lumbar BMD ( r = − 0·195, P = 0·107), which was consistent with our previous report (Nakaoka et al ., 2000a). Intact PTH was negatively and significantly correlated with the baseline z-score of radial BMD ( r = − 0·282, P = 0·015), but not with lumbar BMD ( r = − 0·195, P = 0·107), which was consistent with our previous report (Nakaoka et al ., 2000a).…”

“…At the time of diagnosis, we compared BMD with iPTH by a single regression analysis to determine whether preoperative PTH levels would affect BMD. Intact PTH was negatively and significantly correlated with the baseline z-score of radial BMD ( r = − 0·282, P = 0·015), but not with lumbar BMD ( r = − 0·195, P = 0·107), which was consistent with our previous report (Nakaoka et al ., 2000a). The baseline indices of the patients with and without PTX were compared in Table 1.…”

Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment

“…Как правило, в течение первых 2-3 лет после успешно проведенной паратиреоидэктомии проис-ходит активное восстановление костного метабо-лизма, существенный прирост МПК (в среднем 5-10% за год) в зависимости от выраженности кост-ных потерь и возраста пациента [19,[87][88][89]. В этот период может не требоваться дополнительного ле-чения, за исключением назначения препаратов кальция и активных метаболитов витамина D.…”

Draft of clinical guidelines for the diagnosis and treatment of primary hyperparathyroidism in adult patients

“…Проведение контрольной рентгенденситометрии для оценки прироста МПК рекомендуется пациентам с ПГПТ через год после хирургического лечения и далее 1 раз в год в течение 3-х лет [18,19,149,187,191,192,318,319].…”