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Development of low‐turnover bone diseases after parathyroidectomy and autotransplantation
Author(s) -
Yajima Aiji,
Ogawa Yoshihide,
Ikehara Akashi,
Tominaga Takashi,
Inou Tsunamasa,
Otsubo Osamu
Publication year - 2001
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1046/j.1442-2042.2001.00340.x
Subject(s) - osteoid , medicine , osteomalacia , bone remodeling , autotransplantation , renal osteodystrophy , endocrinology , parathyroid hormone , parathyroidectomy , urology , hyperparathyroidism , osteocalcin , vitamin d and neurology , transplantation , alkaline phosphatase , kidney disease , calcium , chemistry , biochemistry , enzyme
Parathyroidectomy and immediate autotransplantation (PTX‐AT) has been shown to decrease bone pain and increase bone mineral density. However, adynamic bone disease (ABD) has been predicted to develop if the serum intact parathyroid hormone (i‐PTH) level remains lower than normal for a long period of time. Therefore, we investigated the bone histology of patients whose serum i‐PTH levels did not increase over 70 pg/mL for 1 year after PTX‐AT. Four chronic hemodialysis patients were investigated. The serum intact osteocalcin (i‐OC) level was measured and histomorphometry for cancellous bone was performed 1 year after the operation. Tetracycline hydrochloride was administered in the 12 weeks after PTX‐AT. The serum i‐PTH levels were 20.5 ± 15.0 pg/mL and i‐OC levels were 19.5 ± 0.9 ng/mL. Histomorphometric analyses showed the osteoclast surface to be 0.1% in two cases and 0% in the other two cases, the eroded surface was 7.7 ± 6.1%, and the fibrosis volume and osteoblast surface were 0% in all four cases. Osteoid volume, osteoid surface and osteoid thickness were lower in cases 1–3, but higher in case 4. All tetracycline labelings were in contact with the mineralization front in cases 1 and 3, but some were not in cases 2 and 4. Serum i‐PTH and i‐OC levels indicated that ABD developed in these four cases. Histomorphometric analyses revealed that ABD developed in case 1, while either ABD or low‐turnover osteomalacia developed in cases 2 and 4, and low‐turnover osteomalacia was observed in case 3 after PTX‐AT. In conclusion, i‐PTH should not be maintained at lower levels to avoid low‐turnover bone diseases.