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Changes in bone mass and metabolism after surgery for primary hyperparathyroidism
Author(s) -
Garton Mark,
Martin James,
Stewart Alison,
Krukowskl Zygmunt,
Matheson Norman,
Roblns Simon,
Loverldge Nigel,
Reld David
Publication year - 1995
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1995.tb02668.x
Subject(s) - primary hyperparathyroidism , medicine , urology , trochanter , parathyroidectomy , osteoporosis , femoral neck , osteocalcin , bone remodeling , bone density , asymptomatic , endocrinology , hyperparathyroidism , surgery , parathyroid hormone , calcium , alkaline phosphatase , chemistry , biochemistry , enzyme
Summary BACKGROUND AND OBJECTIVE Bone mass Is often reduced In patients with primary hyperparathyroidism (pHPT) and Is usually partially reversible after parathyroidectomy. However, site specific and overall skeletal benefits of surgery in mild asymptomatic pHPT remain uncertain. DESIGN Cross‐sectional and longitudinal studies. PATIENTS Fourteen patients (12 women and 2 men) with pHPT. MEASUREMENTS Baseline bone mass was assessed at the lumbar spine, left hip and whole body using dual‐energy X‐ray absorptiometry, and at the left os calcls using broad‐band ultrasound attenuation. Changes in bone mass, serum Intact PTH and osteocalcin, and urinary pyrldlnium cross‐link excretion were recorded In 10 patients followed for 6 months after surgery. RESULTS (1) Cross‐sectional study: Baseline measurements at the lumbar spine and hip were Inversely related to both the serum PTH concentration and the weight of the parathyroid gland removed at surgery. (2) Longitudinal study: Six months after adenectomy, bone mass had Increased significantly at the femoral neck, greater trochanter, whole body and os calcis, but not at the lumbar spine or Ward's area. Serum PTH, osteocalcin and pyrldlnium cross‐link excretion all fell significantly after surgery. The percentage Increment In whole body bone mineral content at 6 months was proportional to the baseline PTH. CONCLUSION In primary hyperparathyroidism, preoperative reductions and post‐operative gains in bone mass are proportional to the Initial serum PTH concentration. Mild primary hyperparathyroidism probably does not cause appreciable bone loss at clinically relevant fracture sites such as the spine and hip, and In such cases the overall skeletal benefits of surgery are likely to be negligible.