Oral Alendronate Increases Bone Mineral Density in Postmenopausal Women with Primary Hyperparathyroidism

Chow, Chun‐Chung; Chan, Wing-Bun; Li, June K.Y.; Chan, Norman N.; Chan, Michael; Ko, Gary T.C.; Lo, Kwok-Wing; Cockram, Clive S.

doi:10.1210/jc.2002-020890

Cited by 178 publications

(104 citation statements)

References 36 publications

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“…Data from randomized controlled studies have consistently demonstrated that oral alendronate decreases bone turnover and increases BMD in patients with mild PHPT, although the effects on serum calcium have been inconsistent (169)(170)(171) (A-1B).…”

Section: Bisphosphonatesmentioning

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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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: Bisphosphonatesmentioning

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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“…They also slightly increase the bone mineral density parameters at the lumbar spine and hip but not at the distal radius. Their possible long-term disadvantages must not be overlooked (62,63,64).…”

Section: )mentioning

confidence: 99%

Is surgery necessary for ‘mild’ or ‘asymptomatic’ hyperparathyroidism?

Niederle¹,

Wémeau

2015

European Journal of Endocrinology

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A large majority of the currently diagnosed patients with hyperparathyroidism (PHPT) are mild or asymptomatic, mainly women after menopause. Following the debate held at the 16th European Congress of Endocrinology in Wroclaw (Poland) from May 3-7, 2014, arguments are here presented by a surgeon and a medical practitioner considering these situations rather have to profit from surgery, or simply from survey. For the trained endocrine surgeon, it is evident that parathyroidectomy confirms the diagnosis and undoubtedly reduces the discomfort felt by certain patients, prevents all risks of complications, removes patients and medical teams from the monitoring and represents a real individual financial benefit. On the other hand, the medical practitioner considers that mild or asymptomatic PHPT is commonly stable, and very rare are the subjects at risk of complications, particularly of fractures; prevention of vascular and metabolic disorders, nephrolithiasis and bone rarefaction justify regular physical exercise, a safe alimentation, a sufficient calcium and high water intake, the correction of the frequent deficit in vitamin D; finally has also to be considered the impossibility to refer to specialized (endocrine) surgeons, the enormous cohort of subjects more than 50 years with 'mild' or 'asymptomatic' PHPT. The surgeon and the medical practitioner agree to consider that in patients with 'mild' or 'asymptomatic' disease, there is no place for medical treatments, in particular calcimimetics and bisphophonates. Both agree that further studies are needed to clarify the long-term prognosis of operated and non-operated PHPT in term of fractures, cardiovascular risk and mortality. Individual and collective cost/benefit ratios of surgery or survey are also still imperfectly evaluated.

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“…An additional potential benefit of bisphosphonates in primary hyperparathyroidism would be to increase bone mineral density. Two well-controlled double-blinded randomized clinical trials have been conducted (47,48). The study of Khan et al (48) was a randomized, placebocontrolled, study of 44 patients who were administered either alendronate 10 mg daily or placebo.…”

Section: Bisphosphonatesmentioning

confidence: 99%

Asymptomatic primary hyperparathyroidism

Bilezikian

Rubin

Silverberg

2006

Arq Bras Endocrinol Metab

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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

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Oral Alendronate Increases Bone Mineral Density in Postmenopausal Women with Primary Hyperparathyroidism

Cited by 178 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

Is surgery necessary for ‘mild’ or ‘asymptomatic’ hyperparathyroidism?

Asymptomatic primary hyperparathyroidism

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