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

Nomura, Rikako; Sugimoto, Toshitsugu; Tsukamoto, Tatsuo; Yamauchi, Mika; Sowa, Hideaki; Chen, Qingxiang; Yamaguchi, Toru; Kobayashi, Akira; Chihara, Kazuo

doi:10.1111/j.1365-2265.2004.01984.x

Cited by 50 publications

(44 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Observational studies have also demonstrated significant improvement in BMD after PTx (114,135,138,139). In a prospective cohort of 121 patients with PHPT followed for 10 years, there was an increase of 12% to 15% in BMD of patients undergoing PTx (135), especially in the lumbar spine and hip (B-2B).…”

Section: Surgical Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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

show abstract

Section: Surgical Proceduresmentioning

confidence: 99%

“…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

View full text Add to dashboard Cite

show abstract

“…Other studies have also shown this positive effect of PTx on BMD, supporting the notion that osteopenia and osteoporosis are at least partially reversible after PTx (15)(16)(17). In our study, the limited number of X-rays performed in the study population combined with the small number of fractures sustained before or after PTx precludes a meaningful analysis of an effect of PTx on fracture risk.…”

Section: Discussionmentioning

confidence: 42%

“…In PHPT, the importance of achieving cure has been highlighted in a number of studies focusing on the effect of PTx on bone mineral density (BMD), nephrolithiasis, and neurocognitive function (14)(15)(16). Patients who are cured show a significant post-operative increase in bone mass, with BMD remaining significantly above baseline for up to 15 years of follow-up (17).…”

Section: Introductionmentioning

confidence: 99%

No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

Witteveen¹,

Kievit²,

Morreau

et al. 2010

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Cure rate for primary hyperparathyroidism (PHPT) is reported to be 94-100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1-5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT. Design: Evaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1-24 years prior to the study. Patients and methods: We identified 111 patients who underwent initial PTx between 1984 and 2008, and had no MEN-1, MEN-2, or CaR mutation; parathyroid carcinoma; a history of lithium use; or renal failure. Thirty-eight patients were lost to follow-up or were unwilling or unable to participate in the study. Cure was defined as maintenance of normal serum calcium and parathyroid hormone concentrations 6 months after PTx. Results: Cure was achieved in 68 of 73 patients studied (93%) and was sustained in all for 6G5 years. Conclusion: The cure rate of sporadic PHPT after initial surgery is 93%. When cure is achieved, this is sustained in 100% of the patients for up to 24 years post-operatively. Our data suggest that closer early follow-up is advocated in all patients undergoing PTx to definitively establish cure and to provide a safety net for those with residual gland pathology. The data do not support the need for long-term follow-up when cure is established 6 months after PTx.

show abstract

“…Long-term follow up of these patients indicates a 10 to 12 percent improvement in bone density at the lumbar spine and femoral neck over 10 years (31,37). In patients who have nephrolithiasis, surgery is of clear benefit in reducing the incidence of recurrent stones (38). Vague or constitutional symptoms may or may not improve after surgery, while hypertension and peptic ulcer disease, if present, are unlikely to remit.…”

Section: Results Of Surgerymentioning

confidence: 99%

Asymptomatic primary hyperparathyroidism

Bilezikian

Rubin

Silverberg

2006

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or more of the parathyroid glands. In adults with the disease, a single, benign adenoma is seen approximately 80 percent of the time, with multiple gland involvement comprising most of the remaining patients. Very rarely, a parathyroid cancer is responsible but it is seen in less than 0.5 percent of patients with primary hyperparathyroidism. In this article, we will review important clinical and diagnostic features of asymptomatic primary hyperparathyroidism as well as considerations for surgical or medical management of the disease. O hiperparatiroidismo primário é uma distúrbio comum do metabolismo mineral, caracterizado por um excesso de secreção do hormônio das paratiróides, de uma ou mais glândulas paratiroidianas. Nos pacientes adultos portadores da doença, um adenoma único é responsável por aproximadamente 80% dos casos, e o envolvimento de múltiplas glân-dulas pelo restante dos casos. Muito raramente um câncer de paratiróide é a causa, sendo visto em menos de 0,5% dos pacientes com hiperparatiroidismo. Neste artigo, revisaremos as características clínicas e diagnósticas do hiperparatiroidismo primário assintomático, bem como o tratamento clínico e cirúrgico. DIAGNOSIS SINCE IN PRIMARY HYPERPARATHYROIDISM, parathyroid hormone (PTH) is oversecreted, a reliable immunoassay for PTH is essential. The currently available immunoradiometric assay (IRMA) has the requisite sensitivity and specificity, revealing PTH levels that are either frankly elevated or in the upper range of normal. Even though the PTH is sometimes technically in the upper normal range, it is abnormal considering the presence of hypercalcemia. Moreover, in malignancy, the other most common cause of hypercalcemia, the PTH level is classically suppressed even when the cause of the malignancy-related hypercalcemia is parathyroid hormone related protein (PTHrP). Despite the reliability of the IRMA for PTH in general

show abstract

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

Abstract: We demonstrated that PTX led to marked and sustained increases in BMD not only at L2-L4 but also at R1/3 in Japanese pHPT patients, including postmenopausal women. The preoperative PTH level could be a clinically useful index for predicting long-term BMD changes after PTX.

Cited by 50 publications

References 36 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

No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

Asymptomatic primary hyperparathyroidism

Contact Info

Product

Resources

About