Skeletal disease in primary hyperparathyroidism

Abstract

Most patients with primary hyperparathyroidism in the 1980s do not have evidence of bone disease when they are evaluated by conventional radiography. We sought to determine whether skeletal involvement can be appreciated when more sensitive techniques, such as bone densitometry and bone biopsy, are utilized. We investigated 52 patients with primary hyperparathyroidism. They had mild hypercalcemia, 2.8 +/- 0.03 mmol/liter (11.1 +/- 0.1 mg/dl), low normal phosphorus, 0.9 +/- 0.03 mmol/liter (2.8 +/- 0.1 mg/dl), and no symptoms or specific radiological signs of skeletal involvement. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.54 +/- 0.1 g/cm; 79 +/- 2% of expected), whereas the site of predominantly cancellous bone, the lumbar spine (1.07 +/- 0.03 g/cm2), was normal (95 +/- 3% of expected). The site of mixed composition, the femoral neck (0.78 +/- 0.14 g/cm2), gave an intermediate value (89 +/- 2% of expected). Preferential involvement of cortical bone with apparent preservation of cancellous bone in primary hyperparathyroidism was confirmed by percutaneous bone biopsy. Over 80% of patients had a mean cortical width below the expected mean, whereas cancellous bone volume in over 80% of patients was above the expected mean. The results indicate that the majority of patients with asymptomatic primary hyperparathyroidism have evidence by bone densitometry and bone biopsy for cortical bone disease. The results also indicate that the mild hyperparathyroid state may be protective of cancellous bone. The therapeutic implications of these observations await further longitudinal experience with this study population.

Parathyroid carcinoma: a 16-year experience in a single institution

“…Renal involvement, including nephrolithiasis, nephrocalcinosis, and renal insufficiency presents in 30-84% of patients [16], and skeletal involvement, including osteofibrosis, osteoporosis, pathologic fractures, and bone pain occurs in more than 40% of patients [17]. Concomitant renal and skeleton involvement has been observed in up to 50% of patients with parathyroid carcinoma, but it is rare in patients with parathyroid adenoma [15].…”

Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: A one-year prospective controlled study using high-resolution peripheral quantitative computed tomography

“…(1)(2)(3)(4)(5) In cancellous bone, the balance between resorption and formation within each remodeling cycle has been found to be null or slightly positive, and thus trabecular bone mass seems to be preserved or even increased. (1)(2)(3)(4)6,7) In iliac cortical bone, endocortical and intracortical remodeling seem preferentially ORIGINAL ARTICLE J JBMR increased over periosteal remodeling, causing reduced cortical width and/or increased cortical porosity. (2,5,(7)(8)(9) At peripheral sites, alterations of cortical bone geometry have been found consistent with periosteal bone apposition and endocortical bone resorption.…”

“…(1)(2)(3)(4)6,7) In iliac cortical bone, endocortical and intracortical remodeling seem preferentially ORIGINAL ARTICLE J JBMR increased over periosteal remodeling, causing reduced cortical width and/or increased cortical porosity. (2,5,(7)(8)(9) At peripheral sites, alterations of cortical bone geometry have been found consistent with periosteal bone apposition and endocortical bone resorption. (10)(11)(12)(13) Overall, effects appear detrimental to bone integrity as patients with PHPT have been found to have an increased risk of fracture.…”

Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women

“…There also, BMD measurement at the tibia may be a suitable alternative. In patients with metabolic bone diseases, such as hyperparathyroidism, cortical bone loss is known to be more pronounced than trabecular bone loss [15][16] and these patients are at increased risk for fractures [17]. In dialysed renal insufficiency patients, earlier research has provided evidence for the preservation of cortical bone (measured at T-DIA) with continuous ambulatory peritoneal dialysis compared to haemodialysis, possibly in relationship with the higher residual renal function observed in the former [18].…”