Uneven Deficits in Vertebral Bone Density in Postmenopausal Patients with Primary Hyperparathyroidism as Evaluated by Posterior–Anterior and Lateral Dual-Energy Absorptiometry

Abstract

This investigation was undertaken to determine whether the preservation of bone mass in patients with mild primary hyperparathyroidism (PHPT) could be detected when measuring spine density in the lateral projection. We compared the bone mineral density (BMD) of L2-L4 utilizing the posterior-anterior (PA) and lateral projections in postmenopausal patients with PHPT and in a group of 27 postmenopausal normal women. Thirty-three consecutive postmenopausal patients with PHPT were studied; 25 were asymptomatic whereas the remaining 8 suffered complications related to the disease. Based upon the criteria established by the Consensus Conference on the Management of Asymptomatic PHPT, only 10 of the 25 asymptomatic patients could be considered affected by mild disease; the remaining patients were classified as having moderate disease. Patients with mild disease had mean lateral total BMD values (0.682 +/- 0.113 g/cm(2)) significantly higher than normal women (0.588 +/- 0.076, p<0.02) and patients with moderate disease (0.599 +/- 0.077, p<0.05). There were significant differences among the three groups in both PA L2-L4 and L1-L4 levels: patients with mild disease had significantly higher mean BMD values than patients with moderate disease and normal women, when either three or four vertebrae were considered. Interestingly, at this latter site, patients with moderate disease had significantly ( p<0.05) lower values than normal women. Our results indicate that patients with mild PHPT have a preservation of vertebral mass when compared with the other hyperparathyroid patients and normal women, when taking into account both the mainly trabecular portion and the whole vertebra. The finding that when the PA projection was assessed, BMD values of patients with moderate disease were significantly lower than those of normal women, might be attributed to the detrimental effect of raised parathyroid hormone levels on the cortical component of the vertebral body.

The risk of fractures in postmenopausal women with primary hyperparathyroidism

“…In fact, according to 2002 guidelines, skeletal involvement in M PHPT patients is only evaluated by BMD measurement. As expected, in patients with more severe disease, BMD values were significantly lower at any site compared with both M patients and C. However, confirming our previous results (22), in M patients BMD values at the LS were significantly higher than C, supporting the hypothesis of an anabolic action of PTH on cancellous bone in postmenopausal women with mild disease. To define this action better, we also calculated volumetric BMD of the third lumbar vertebra according to an accepted and widely used method (19).…”

Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: A case-control study using HR-pQCT

“…In the spine, reduction was found in some (28,34,37) but not all (35,36,38) studies, and similarly for the hip, both aBMD reductions (36,37) and no difference (34) have been reported. The aBMD findings in our study are in accordance with those previously described, but we did observed reductions in aBMD at all three skeletal sites.…”

Positive effect of parathyroidectomy on bone mineral density in mild asymptomatic primary hyperparathyroidism*

“…Several reports suggest that these noncharacteristic phenomena of pHPT are also present in asymptomatic as well as in normocalcemic diseases [5, 7, 8]. Whilst low bone mineral density (BMD) is a traditional manifestation of pHPT [9, 10], studies of the characteristic presentation in mild pHPT are contradictory [11, 12]. In addition, population‐based analyses of BMD in mild and asymptomatic pHPT have not been presented.…”