Total body calcium mass in primary hyperparathyroidism and long-term changes

Jimenez, L. E.; Spinks, T.J.; Ranicar, A.; Joplin, G. F.

doi:10.1007/bf02405288

Cited by 17 publications

(5 citation statements)

References 10 publications

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“…However, in the remainder of asymptomatic individuals, there was no deterioration in hypercalcaemia, PTH levels or hypercalciuria. In keeping with most, 18,21–23 but not all, 24 previous smaller and shorter studies, BMD remained low but stable in the observation group not undergoing surgery. In contrast, there was a significant improvement in BMD at the hip and lumbar spine, although not the forearm, in the PTX group.…”

Section: Important Observational Studies Following the 1990 Nih Consesupporting

confidence: 84%

Should ‘Mild Primary Hyperparathyroidism’ be reclassified as ‘insidious’: is it time to reconsider?

Macfarlane

Donnan

et al. 2011

Clinical Endocrinology

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Summary Primary hyperparathyroidism (PHPT) is a common incidental finding on routine biochemical testing, affecting around 1% of the population. The majority of individuals will be asymptomatic at diagnosis, with no evidence of end organ damage, and unless individuals aged <50 years at diagnosis, they are often considered to have ‘mild’ PHPT, as they do not meet published criteria for parathyroidectomy (PTX). However, there is increasing evidence that ‘mild’ PHPT is associated with adverse health outcomes. Long‐term observational studies describing the natural history of ‘mild’ PHPT suggest that even though biochemistry may be relatively stable in the majority, bone mineral density (BMD) does decline after approximately 10 years of observation, whereas significant improvements in BMD are seen following PTX. Recent large European record linkage studies of ‘mild PHPT’ demonstrate significantly increased all‐cause and cardiovascular mortality, similar to rates published for patients with PHPT who meet the NIH surgical criteria. ‘Mild’ PHPT was also associated with increased admissions for nonfatal cardiovascular disease, renal failure, renal stones, fractures, hypertension, psychiatric disease, cancer and diabetes, suggesting that ‘insidious’ PHPT may be a more appropriate description, or at least that the term ‘mild’ should be abandoned. Randomized controlled trials (RCTs) have begun to explore the benefits of PTX in this condition, demonstrating improvements in BMD and some psychiatric outcomes at approximately 2 years of follow‐up. However, larger, adequately powered, long‐term, RCTs will be required to determine whether PTX improves potential long‐term morbidity and mortality in patients with PHPT who do not meet standard surgical criteria.

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Section: Important Observational Studies Following the 1990 Nih Consesupporting

confidence: 84%

Should ‘Mild Primary Hyperparathyroidism’ be reclassified as ‘insidious’: is it time to reconsider?

Macfarlane

Donnan

et al. 2011

Clinical Endocrinology

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“…In the present study, total vBMD signifi cantly decreased in control postmenopausal women, but not in postmenopausal patients with pHPT after two years follow-up. These fi ndings were compatible with the previous fi ndings ( Jimenz et al, 1984 ;Rao et al, 1988 ;Parfi tt et al, 1991 ;Silverberg et al, 1995a;Nomura et al, 2004 ). Therefore, mild PTH excess does not seem to exert bone catabolic action.…”

Section: Time-dependent Changes Of Pqct Indicessupporting

confidence: 92%

“…In a 10-year prospective study of mild pHPT patients without PTX, BMD did not change . Other short-term studies supported the fi ndings that asymptomatic pHPT patients without PTX have stable BMD ( Jimenz et al, 1984 ;Rao et al, 1988 ;Parfi tt et al, 1991 ;Silverberg et al, 1995a ;Nomura et al, 2004 ). In the present study, total vBMD signifi cantly decreased in control postmenopausal women, but not in postmenopausal patients with pHPT after two years follow-up.…”

Section: Time-dependent Changes Of Pqct Indicessupporting

confidence: 87%

Two-year Longitudinal Changes in Forearm Cortical Bone Geometry in Postmenopausal Women with Mild Primary Hyperparathyroidism without Parathyroidectomy

Kaji

Yamauchi²,

Nomura³

et al. 2008

Exp Clin Endocrinol Diabetes

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Several studies suggest that mild PTH excess does not have any deteriorative effects on bone mineral density (BMD) in several-year-longitudinal studies of patients with mild primary hyperparathyroidism (pHPT) without parathyroidectomy (PTX). However, it remains unknown about the change in bone geometry in pHPT patients without PTX. We examined the longitudinal effects of mild PTH excess on cortical bone geometry in postmenopausal patients with mild pHPT without PTX by using peripheral quantitative computed tomography (pQCT), and we compared them with normal and hypoparathyroidism women. Nine postmenopausal female patients who were diagnosed as pHPT, six postmenopausal female patients with hypoparathyroidism (3 idiopathic and 3 postoperative), and thirty postmenopausal control subjects participated in this study. Radial volumetric (v) BMD and several bone geometry parameters were measured by pQCT at basal line and after 2 years. Cortical vBMD was significantly lower in pHPT group. Moreover, total area and periosteal circumferences were significantly higher in pHPT group. Total and cortical vBMD were significantly decreased after 2 years in control group. However, they were stable in pHPT group after 2-year follow-up. As for bone geometry, cortical thickness and area were also stable in pHPT group during 2-year follow-up, although they were significantly reduced in control group and hypoparathyroidism group. In conclusion, the present longitudinal study revealed that there were no significant changes in radial vBMD and cortical bone geometry in postmenopausal women with mild pHPT, whereas age-related thinning of cortical bone as well as decrease of vBMD were observed in the control and patients with hypoparathyroidism.

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“…In opposition to the relative agreement observ¬ ed in the studies that had evaluated cortical bone mass in PHPT patients, the measurements of the total bodv calcium have been somewhat contradic¬ tory, specially regarding the changes that occur after parathyroidectomy (Hosking et al 1972;Cohn et al 1973;Jiménez et al 1984). The discrepancy could be due to technical reasons or due the fact that the cortical bone measurement is more sensitive to small changes than the total body calcium.…”

Section: Discussionmentioning

confidence: 98%

Cortical bone mineral content in primary hyperparathyroidism. Changes after parathyroidectomy

Mautalén

Reyes

Ghiringhelli

et al. 1986

Acta Endocrinologica

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Abstract. The bone mineral content (BMC) of 35 patients with primary hyperparathyroidism (PHPT) was measured at the mid radius (95% cortical bone) by photon absorptiometry of a 241Am source. The majority of the patients had an overt disease of moderate to severe degree. Average serum calcium of the group was 12.3 mg/100 ml (range 10.6 to 18.0 mg/100 ml). The percentage of normality of the BMC was (Av ± 1 sd) 75.1 ± 13.0% for the whole group. The average increment of BMC in 14 patients 9 to 26 months after parathyroidectomy was 9.9%, with a wide dispersion. However a highly significant negative correlation (r: 0.83; P < 0.01) was found between the initial bone mass and the percentage increment per month after surgery. No further gain was observed 2 years after parathyroidectomy except in one patient with an extremely severe bone loss. In spite of the gain obtained after surgery the bone mass remained markedly diminished in most patients showing that the cortical bone loss caused by PHPT is mainly irreversible.

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Total body calcium mass in primary hyperparathyroidism and long-term changes

Cited by 17 publications

References 10 publications

Should ‘Mild Primary Hyperparathyroidism’ be reclassified as ‘insidious’: is it time to reconsider?

Should ‘Mild Primary Hyperparathyroidism’ be reclassified as ‘insidious’: is it time to reconsider?

Two-year Longitudinal Changes in Forearm Cortical Bone Geometry in Postmenopausal Women with Mild Primary Hyperparathyroidism without Parathyroidectomy

Cortical bone mineral content in primary hyperparathyroidism. Changes after parathyroidectomy

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