Hyperparathyroidism and Bone Health

Bandeira, Francisco; Cassibba, Sara

doi:10.1007/s11926-015-0523-2

Cited by 31 publications

(18 citation statements)

References 55 publications

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“…Several studies have reported significant BMD gain following parathyroidectomy [14][15][16][17]26,28]. The BMD was lower in patients with severe PHPT and significant improvements were observed after surgical cure, which is consistent with our results [17,29]. Skeletal abnormalities regressed and osteoclastoma shrunk with BMD gain following successful parathyroidectomy in severe PHPT [9,30,31].…”

Section: Discussionsupporting

confidence: 90%

The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism

2019

Turk J Med Sci

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Background/aim: This study aimed to investigate the change in bone mineral density (BMD) before and 1 year after parathyroidectomy in patients with primary hyperparathyroidism (PHPT). Materials and methods: The clinical and biochemical parameters and DEXA screening of patients with symptomatic PHPT (n = 28) and asymptomatic PHPT (n = 63) were investigated before and 1 year after parathyroidectomy. Results: Patients with symptomatic PHPT had a higher prevalence of nephrolithiasis (18.2% vs. 4.6%, P = 0.032) when compared to the prevalence in patients with asymptomatic PHPT. The prevalence of osteoporosis in the lumbar spine (63.0% vs. 37.5%, P = 0.026) and femoral neck (40.7% vs. 20.6%, P = 0.048) was higher in symptomatic PHPT when compared to the prevalence in asymptomatic PHPT. After parathyroidectomy, the decreases in the prevalence of osteoporosis in the lumbar spine (25.8% vs. 9.4%, P = 0.014), femoral neck (22.1% vs. 8.2%, P =0.009), and total hip (22.4% vs. 5.3%, P = 0.007) were higher in symptomatic PHPT compared to the asymptomatic PHPT group. A higher BMD gain (g/cm 2) was seen in the lumbar spine (10.83% vs. 4.65%, P=0.016) and femoral neck (12.61% vs. 4.37%, P=0.005) in symptomatic PHPT compared to the asymptomatic PHPT group. Conclusion: Parathyroidectomy provided more BMD gain in the lumbar spine and femoral neck in patients with symptomatic PHPT when compared to patients with asymptomatic PHPT 1 year after parathyroidectomy.

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Section: Discussionsupporting

confidence: 90%

The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism

2019

Turk J Med Sci

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“…Other causes of hyperparathyroidism due to a normal physiological stimulus to increased PTH levels — secondary hyperparathyroidism states — should be excluded (BOX 2). Bone resorption inhibitors, such as bisphosphonates and denosumab, usually cause increases in serum PTH concentrations, rendering a diagnosis of normocalcaemic PHPT under these conditions uncertain 120,121 . The diagnosis of parathyroid gland autonomy in the setting of chronic kidney disease is more challenging.…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Primary hyperparathyroidism

Bilezikian

Cusano

Khan

et al. 2016

Nat Rev Dis Primers

Self Cite

192

157

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Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes. Hypercalcaemia is the biochemical hallmark of PHPT. Usually, the concentration of PTH is frankly increased but can remain within the normal range, which is abnormal in the setting of hypercalcaemia. Normocalcaemic PHPT, a variant in which the serum calcium level is persistently normal but PTH levels are increased in the absence of an obvious inciting stimulus, is now recognized. The clinical presentation of PHPT varies from asymptomatic disease (seen in countries where biochemical screening is routine) to classic symptomatic disease in which renal and/or skeletal complications are observed. Management guidelines have recently been revised to help the clinician to decide on the merits of a parathyroidectomy or a non-surgical course. This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT.

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“…However, skeletal involvement continues to be readily detected by technologies such as DXA 15 , 21 . Reduced BMD is observed most often in distal 1/3 radius site, comprised mostly of cortical bone, with relative preservation of lumbar spine, a site that is endowed primarily with trabecular bone 22 . However, these densitometric findings are not consistent with epidemiological data that have consistently reported a greater incidence of fractures at trabecular (vertebral) as well as cortical (non-vertebral) sites in PHPT.…”

Section: Clinical Presentationmentioning

confidence: 99%

Primary Hyperparathyroidism

Bandeira

Bilezikian

2016

F1000Res

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Over the past several generations, primary hyperparathyroidism (PHTP) has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation. It is clear that even in asymptomatic patients, evidence for microstructural disease in the skeleton and calcifications in the kidneys can be demonstrated often. Potential non-classical manifestations of PHPT related to neurocognition and the cardiovascular system continue to be of interest. As a result of these advances, revised guidelines for the management of asymptomatic PHPT have been recently published to help the clinician determine whether surgery is appropriate or whether a more conservative approach is acceptable.

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Hyperparathyroidism and Bone Health

Cited by 31 publications

References 55 publications

The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism

The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism

Primary hyperparathyroidism

Primary Hyperparathyroidism

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