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Szulc P. Biochemical bone turnover markers in hormonal disorders in adults: a narrative review. J Endocrinol Invest 2020; 43:1409-1427. [PMID: 32335857 DOI: 10.1007/s40618-020-01269-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hormonal disorders are often associated with abnormal levels of bone turnover markers (BTMs). N-terminal propeptide of type I procollagen (PINP) and serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) are the reference markers of bone formation and bone resorption, respectively. METHODS A comprehensive literature search within the MEDLINE and Web of Science databases was performed. RESULTS Acromegaly is associated with higher BTM levels, which decrease during the remission after treatment. Adult-onset growth hormone deficiency is often associated with decreased BTM levels. Growth hormone replacement therapy stimulates bone turnover and increases BTM levels. Hypothyroidism is characterized by general slowing of bone metabolism which is reflected by lower BTM levels. The replacement thyroid hormone therapy increases the bone turnover rate and BTM levels increase. Patients with thyroid cancer receive a suppressive dose of thyroid hormones and may have slightly elevated BTM levels. Patients with overt hyperthyroidism had higher BTM levels and anti-thyroid therapy induces a rapid decrease in the BTM levels. Patients with overt primary hyperparathyroidism have higher BTM levels, whereas those with asymptomatic and normocalcemic hyperparathyroidism usually have normal BTM levels. Hypoparathyroidism is characterized by slightly decreased BTM levels. Cushing's syndrome is characterized consistently by markedly decreased osteocalcin concentration, whereas data on other BTMs are discordant. CONCLUSIONS BTMs help us to better understand mechanisms of the impact of hormonal disorders and their treatment on bone metabolism. However, it is unknown whether BTMs may be used to monitor the effect of their treatments on bone in the clinical practice.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Dalemo S, Eggertsen R, Hjerpe P, Almqvist EG, Boström KB. Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden. Scand J Prim Health Care 2018; 36:198-206. [PMID: 29623754 PMCID: PMC6066277 DOI: 10.1080/02813432.2018.1459430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Elevated calcium concentration is a commonly used measure in screening analyses for primary hyperparathyroidism (pHPT) and cancer. Low bone mineral density (BMD) and osteoporosis are common features of pHPT and strengthen the indication for parathyroidectomy. It is not known whether an elevated calcium concentration could be a marker of low BMD in suspected pHPT patients with a normal parathyroid hormone concentration. PURPOSE To study if low BMD and osteoporosis are more common after ten years in patients with elevated compared with normal calcium concentrations at baseline. DESIGN Prospective case control study. SETTING Primary care, southern Sweden. SUBJECTS One hundred twenty-seven patients (28 men) with baseline elevated, and 254 patients (56 men) with baseline normal calcium concentrations, mean age 61 years, were recruited. After ten years, 77% of those still alive (74 with elevated and 154 with normal calcium concentrations at baseline) participated in a dual energy x-ray absorptiometry measurement for BMD assessment and analysis of calcium and parathyroid hormone concentrations. MAIN OUTCOME MEASURES Association between elevated and normal calcium concentration at base-line and BMD at follow-up. Correlation between calcium and parathyroid hormone concentrations and BMD at follow-up. RESULTS A larger proportion of the patients with elevated baseline calcium concentrations who participated in the follow-up had osteoporosis (p value = 0.036), compared with the patients with normal concentrations. In contrast, no correlation was found between calcium or parathyroid hormone concentrations and BMD at follow-up. CONCLUSIONS In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%), which highlights the importance of examining these patients further using absorptiometry, even when their parathyroid hormone level is normal. Key Points Osteoporosis is common, difficult to detect and usually untreated. It is not known whether elevated calcium concentrations, irrespective of the PTH level, could be a marker of low bone mineral density. No correlation was found between calcium or parathyroid hormone concentrations and bone mineral density at follow-up. In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%).
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Affiliation(s)
- Sofia Dalemo
- Institute of Medicine/Dept. of Public Health and Community/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Närhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden;
- CONTACT Sofia DalemoInstitute of Medicine/Dept. of Public Health and Community/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert Eggertsen
- Institute of Medicine/Dept. of Public Health and Community/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Närhälsan Mölnlycke Primary Health Care and Research Centre, Gothenburg, Sweden;
| | - Per Hjerpe
- Närhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden;
| | - Erik G. Almqvist
- Department of Internal Medicine, Skaraborg Hospital, Skövde, Sweden
| | - Kristina Bengtsson Boström
- Institute of Medicine/Dept. of Public Health and Community/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Närhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden;
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3
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Rossini M, Adami G, Viapiana O, Idolazzi L, Orsolini G, Fassio A, Giollo A, Gatti D. Osteoporosis: an Independent Determinant of Bone Erosions in Rheumatoid Arthritis? J Bone Miner Res 2017; 32:2142-2143. [PMID: 28670771 DOI: 10.1002/jbmr.3209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Orsolini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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4
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Akbaba G, Isik S, Ates Tutuncu Y, Ozuguz U, Berker D, Guler S. Comparison of alendronate and raloxifene for the management of primary hyperparathyroidism. J Endocrinol Invest 2013; 36:1076-82. [PMID: 24081023 DOI: 10.3275/9095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To evaluate and compare the efficacy of alendronate sodium (ALN) and raloxifene (RLX) for the management of primary hyperparathyroidism (PHPT) in postmenopausal female patients (pts) with osteoporosis. METHODS Twenty-four postmenopausal women with osteoporosis who were diagnosed with PHPT, but refused the option of surgery, were enrolled. Participants were sequentially randomized into two groups: an ALN-group of 12 pts (70 mg/week) and a RLX-group of 12 pts (60 mg/day). The control group consisted of 10 pts with PHPT who did not have any indications for surgery. RESULTS The decrease in ionized calcium levels was significantly more pronounced in the ALN group compared to the RLX and control groups (p<0.001). In terms of difference from baseline in bone mineral density (BMD) of the lumbar area in percentages over a period of 12 months, pts in the ALN and RLX groups both showed statistically significant improvements compared to pts in the control group (control vs ALN, p<0.001; control vs RLX, p<0.001). BMD measurements of the femoral and radial areas were comparable in all three groups. CONCLUSIONS ALN and RLX may improve bone density in the lumbar area of osteoporotic post-menopausal women with PHPT. The more significant decrease in serum calcium levels which was observed in the ALN group compared to both RLX and control groups, suggests that ALN could be used for the short-term control of calcium levels in patients awaiting surgery.
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Affiliation(s)
- G Akbaba
- Ministry of Health, Mugla Sıtkı Kocman University Research and Training Hospital, Endocrinology and Metabolism Diseases Clinic, Aydın Yolu Bulvarı, Menteşe Evleri, Nil Sitesi, F Blok No 6, Mugla, Turkey.
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5
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Stein EM, Silva BC, Boutroy S, Zhou B, Wang J, Udesky J, Zhang C, McMahon DJ, Romano M, Dworakowski E, Costa AG, Cusano N, Irani D, Cremers S, Shane E, Guo XE, Bilezikian JP. Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women. J Bone Miner Res 2013; 28:1029-40. [PMID: 23225022 PMCID: PMC3631282 DOI: 10.1002/jbmr.1841] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/09/2012] [Accepted: 11/26/2012] [Indexed: 12/24/2022]
Abstract
Typically, in the milder form of primary hyperparathyroidism (PHPT), now seen in most countries, bone density by dual-energy X-ray absorptiometry (DXA) and detailed analyses of iliac crest bone biopsies by histomorphometry and micro-computed tomography (µCT) show detrimental effects in cortical bone, whereas the trabecular site (lumbar spine by DXA) and the trabecular compartment (by bone biopsy) appear to be relatively well preserved. Despite these findings, fracture risk at both vertebral and nonvertebral sites is increased in PHPT. Emerging technologies, such as high-resolution peripheral quantitative computed tomography (HRpQCT), may provide additional insight into microstructural features at sites such as the forearm and tibia that have heretofore not been easily accessible. Using HRpQCT, we determined cortical and trabecular microstructure at the radius and tibia in 51 postmenopausal women with PHPT and 120 controls. Individual trabecula segmentation (ITS) and micro-finite element (µFE) analyses of the HRpQCT images were also performed to further understand how the abnormalities seen by HRpQCT might translate into effects on bone strength. Women with PHPT showed, at both sites, decreased volumetric densities at trabecular and cortical compartments, thinner cortices, and more widely spaced and heterogeneously distributed trabeculae. At the radius, trabeculae were thinner and fewer in PHPT. The radius was affected to a greater extent in the trabecular compartment than the tibia. ITS analyses revealed, at both sites, that plate-like trabeculae were depleted, with a resultant reduction in the plate/rod ratio. Microarchitectural abnormalities were evident by decreased plate-rod and plate-plate junctions at the radius and tibia, and rod-rod junctions at the radius. These trabecular and cortical abnormalities resulted in decreased whole-bone stiffness and trabecular stiffness. These results provide evidence that in PHPT, microstructural abnormalities are pervasive and not limited to the cortical compartment, which may help to account for increased global fracture risk in PHPT.
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Affiliation(s)
- Emily M Stein
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Barbara C Silva
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- College of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Stephanie Boutroy
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Julia Udesky
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Chiyuan Zhang
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Donald J McMahon
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Megan Romano
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elzbieta Dworakowski
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Aline G. Costa
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Natalie Cusano
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dinaz Irani
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serge Cremers
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elizabeth Shane
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - John P Bilezikian
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Hansen S, Hauge EM, Rasmussen L, Jensen JEB, Brixen K. 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. J Bone Miner Res 2012; 27:1150-8. [PMID: 22228118 DOI: 10.1002/jbmr.1540] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Following parathyroidectomy (PTX), bone mineral density (BMD) increases in patients with primary hyperparathyroidism (PHPT), yet information is scarce concerning changes in bone structure and strength following normalization of parathyroid hormone levels postsurgery. In this 1-year prospective controlled study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to evaluate changes in bone geometry, volumetric BMD (vBMD), microarchitecture, and estimated strength in female patients with PHPT before and 1 year after PTX, compared to healthy controls. Twenty-seven women successfully treated with PTX (median age 62 years; range, 44-75 years) and 31 controls (median age 63 years; range, 40-76 years) recruited by random sampling from the general population were studied using HR-pQCT of the distal radius and tibia as well as with dual-energy X-ray absorptiometry (DXA) of the forearm, spine, and hip. The two groups were comparable with respect to age, height, weight, and menopausal status. In both radius and tibia, cortical (Ct.) vBMD and Ct. thickness increased or were maintained in patients and decreased in controls (p < 0.01). Radius cancellous bone architecture was improved in patients through increased trabecular number and decreased trabecular spacing compared with changes in controls (p < 0.05). No significant cancellous bone changes were observed in tibia. Estimated bone failure load by finite element modeling increased in patients in radius but declined in controls (p < 0.001). Similar, albeit borderline significant changes in estimated failure load were found in tibia (p = 0.06). This study showed that females with PHPT had improvements in cortical bone geometry and increases in cortical and trabecular vBMD in both radius and tibia along with improvements in cancellous bone architecture and estimated strength in radius 1 year after PTX, reversing or attenuating age-related changes observed in controls.
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Affiliation(s)
- Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
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7
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Chang YJ, Yu W, Lin Q, Yao JP, Zhou XH, Tian JP. Forearm bone mineral density measurement with different scanning positions: a study in right-handed Chinese using dual-energy X-ray absorptiometry. J Clin Densitom 2012; 15:67-71. [PMID: 22154427 DOI: 10.1016/j.jocd.2011.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 11/29/2022]
Abstract
The purpose of our study was to determine whether different scanning positions influence forearm bone mineral density (BMD) measurements and to evaluate the association between forearm BMDs in different scanning positions and those of other skeleton sites. The study population consisted of 30 right-handed healthy Chinese volunteers. BMD was measured with GE Lunar Prodigy at the left forearm in both sitting and supine positions, and at lumbar spine and the right femur. All subjects received repeated measurements in the same day (repositioning), and the average of repeated BMD results was used for analysis. The BMD precision errors of the nondominant forearm in the sitting and supine positions varied from 1.13% to 2.46%. There were no statistically significant differences between BMD precision errors for each region of interest (ROI) between sitting and supine positions (all the p values were greater than 0.05). When comparing BMDs on the same side in the sitting position with those in the supine position, there were significant differences at both the 1/3 radius level and in the total radius (p<0.05). The BMD values at these ROIs obtained in the supine position were lower than those in the routine sitting position. The BMDs of the ultradistal radius in the both 2 different scanning positions were significantly associated with lumbar spine and femoral neck BMD, respectively. The total radius BMD in the different positions was associated with the BMD of the femoral neck. A change in body scanning position from sitting to supine will significantly influence forearm BMD results.
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Affiliation(s)
- Yin-Juan Chang
- Department of Radiology, Chinese Academy of Medicine Science, Beijing, China
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8
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Lewiecki EM. Management of skeletal health in patients with asymptomatic primary hyperparathyroidism. J Clin Densitom 2010; 13:324-34. [PMID: 21029971 DOI: 10.1016/j.jocd.2010.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/18/2010] [Accepted: 06/18/2010] [Indexed: 12/26/2022]
Abstract
Asymptomatic primary hyperparathyroidism (PHPT) may cause adverse skeletal effects that include high bone remodeling, reduced bone mineral density (BMD), and increased fracture risk. Parathyroid surgery, the definitive treatment for PHPT, has been shown to increase BMD and appears to reduce fracture risk. Current guidelines recommend parathyroid surgery for patients with symptomatic PHPT or asymptomatic PHPT with serum calcium >1mg/dL above the upper limit of normal, calculated creatinine clearance <60 mL/min, osteoporosis, previous fracture, or age <50 yr. The type of operation performed (parathyroid exploration or minimally invasive procedure) and localizing studies to identify the abnormal parathyroid glands preoperatively should be individualized according to the skills of the surgeon and the resources of the institution. In patients who choose not to be treated surgically or who have contraindications for surgery, medical therapy should include a daily calcium intake of at least 1200 mg and maintenance of serum 25-hydroxyvitamin D levels of at least 20 ng/mL (50 nmol/L). Bisphosphonates and estrogens have been shown to provide skeletal benefits that appear to be similar to parathyroid surgery. Cinacalcet reduces serum calcium in PHPT patients with intractable hypercalcemia but has not been shown to improve BMD. It is not known whether any medical intervention reduces fracture risk in patients with PHPT. There are insufficient data on the natural history and treatment of normocalcemic PHPT to make recommendations for management of this disorder.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM 87106, USA.
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9
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Boasquevisque E, Wagner Esteves da Silva J, de Albuquerque Bernardo VV, Mello Santana de Macedo S, Boasquevisque CS, Ribeiro Nogueira de Oliveira A, Tami Pires Kasai E, Mandarim-de-Lacerda CA. 99mTc-MDP bone uptake in secondary hyperparathyroidism: comparison of the mandible, cranium, radius, and femur. Oral Radiol 2008. [DOI: 10.1007/s11282-008-0075-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Abstract
Today, primary hyperparathyroidism (PHPT) in the developed countries is typically a disease with few or no obvious clinical symptoms. However, even in the asymptomatic cases the endogenous excess of PTH increases bone turnover leading to an insidious reversible loss of cortical and trabecular bone because of an expansion of the remodelling space and an irreversible loss of cortical bone due to increased endocortical resorption. In contrast trabecular bone structure and integrity to a large extent is maintained and there may be a slight periosteal expansion. Most studies have reported decreased bone mineral density (BMD) in PHPT mainly located at cortical sites, whereas sites rich in trabecular bone only show a modest reduction or even a slight increase in BMD. The frequent occurrence of vitamin D insufficiency and deficiency in PHPT and increased plasma FGF23 levels may also contribute to the decrease in BMD. The effect of smoking is unsolved. Epidemiological studies have shown that the relative risk of spine and nonspine fractures is increased in untreated PHPT starting up to 10 years before the diagnosis is made. Successful surgery for PHPT normalizes bone turnover, increases BMD and decreases fracture risk based on larger epidemiological studies. However, 10 years after surgery fracture risk appears to increase again due to an increase in forearm fractures. There are no randomized controlled studies (RCTs) demonstrating a protective effect of medical treatment on fracture risk in PHPT. Less conclusive studies suggest that vitamin D supplementation may have a beneficial effect on plasma PTH and BMD in vitamin D deficient PHPT patients. Hormone replacement therapy (HRT) and maybe SERM appear to reduce bone turnover and increase BMD. However, their nonskeletal side-effects preclude their use for this purpose. Bisphosphonates reduce bone turnover and increase BMD in PHPT as in osteoporosis and may be a therapeutical option in selected patients with low BMD. Obviously, there is a need for larger RCTs with fractures as end-points that appraise this possibility. Calcimimetics reduce plasma calcium and PTH in PHPT but has no beneficial effect on bone turnover or BMD. In symptomatic hypercalcaemic PHPT with low BMD where curative surgery is impossible or contraindicated a combination of a calcimimetic and a bisphosphonate may be an undocumented therapeutical option that needs further evaluation.
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Affiliation(s)
- Leif Mosekilde
- Department of Endocrinology and Metabolism C, Aarhus University Hospital, DK 8000, Aarhus C, Denmark.
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11
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Moosgaard B, Christensen SE, Vestergaard P, Heickendorff L, Christiansen P, Mosekilde L. Vitamin D metabolites and skeletal consequences in primary hyperparathyroidism. Clin Endocrinol (Oxf) 2008; 68:707-15. [PMID: 17980013 DOI: 10.1111/j.1365-2265.2007.03109.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is associated with reduced bone mineral density (BMD) mainly at sites rich in cortical bone. However, successful parathyroidectomy causes an increase in BMD especially at sites rich in trabecular bone. Plasma 25-hydroxyvitamin D (25OHD) levels are typically reduced and plasma 1,25-dihydroxyvitamin D [1,25(OH)(2)D] slightly increased in PHPT. These variations in vitamin D metabolites may influence variations in BMD and fracture risk. AIM To investigate relations between preoperative vitamin D metabolites and skeletal consequences in patients with untreated PHPT and to appraise the influence of preoperative vitamin D metabolites on postoperative changes in BMD. Design Cross-sectional and cohort study. MATERIALS Two hundred and forty-six consecutive Caucasian PHPT patients aged 19-91 years. (median 63, 87% females). RESULTS BMD was reduced at the femoral neck (P < 0.001) and forearm (P < 0.001), but normal at the lumbar spine (P = 0.11). Levels of biochemical bone markers were associated with high plasma PTH, high plasma 1,25(OH)(2)D and low plasma levels of 25OHD. Moreover, low plasma 25OHD was associated with low levels of BMD at the femoral neck (r(p) = 0.23), the forearm (r(p) = 0.19) and the whole body (r(p) = 0.30), whereas plasma 1,25(OH)(2)D was inversely associated with BMD at all regional sites and the whole body. Plasma PTH only showed an inverse association with BMD at the forearm (r(p) = -0.21). No association was observed between biochemical variables and prevalent spinal fractures, all peripheral fractures or osteoporotic peripheral fractures. The annual increase in spinal BMD after surgery was positively associated with preoperative plasma PTH (r(p) = 0.40), whereas the annual increase in whole body BMD was inversely associated with plasma 25OHD (r(p) = -0.32). No change in BMD at the femoral neck and forearm was observed 1 year after surgery. CONCLUSION Low vitamin D status and high plasma 1,25(OH)(2)D are associated with increased bone turnover and decreased BMD in patients with PHPT.
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Affiliation(s)
- B Moosgaard
- Aarhus Bone and Mineral Research Group: Department of Endocrinology and Metabolism C, Aarhus University Hospital, DK 8000 Aarhus C, Denmark.
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12
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Pearson D, Horton B, Green DJ. Cross calibration of Hologic QDR2000 and GE Lunar Prodigy for forearm bone mineral density measurements. J Clin Densitom 2007; 10:306-11. [PMID: 17584510 DOI: 10.1016/j.jocd.2007.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 04/26/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to carry out an in vivo cross calibration for forearm bone mineral density (BMD) between a Hologic QDR2000 (Hologic Inc., Bedford MA, USA) and Lunar Prodigy (GE Healthcare, Madison WI, USA) during equipment upgrade. Nineteen subjects (17 females and 2 males, mean age 57 yr, range: 42-79yr) attending for routine dual energy X-ray absorptiometry scanning were recruited. BMD of the nondominant forearm was measured on both instruments. Cross-calibration equations were derived for total forearm, ultradistal radius and ulna, and 33% radius and ulna. A Bland & Altman plot was used to calculate the mean difference and limits of agreement between instruments. There were significant differences in BMD at all sites. The Prodigy BMD was 15% higher at the total forearm and 20-25% higher in the cortical regions of the 33% ulna and 33% radius. The differences are smaller in the ultradistal regions, as it appears that the Prodigy underestimates BMD at low BMD. The standard error of estimate about the cross calibration was such that it cannot be used to transfer individual patients between instruments, but could be applied to clinical trial data.
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Affiliation(s)
- D Pearson
- Department of Medical Physics & Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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13
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Silverberg SJ, Bilezikian JP. The diagnosis and management of asymptomatic primary hyperparathyroidism. ACTA ACUST UNITED AC 2006; 2:494-503. [PMID: 16957763 DOI: 10.1038/ncpendmet0265] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 04/12/2006] [Indexed: 11/09/2022]
Abstract
Classical primary hyperparathyroidism--a disease of 'bones, stones, and psychic groans'--is a rarity in the US, although it is still seen in some parts of the world. Today, most patients with primary hyperparathyroidism are asymptomatic. This change in clinical profile is not merely because of improved detection techniques, and patients with primary hyperparathyroidism who lack symptoms, if left untreated, rarely develop the 'classical' features that were common previously. Indeed, currently available data suggest that there is, today, a disorder with different, yet characteristic, effects on the end-organs of the hyperparathyroid process. In this review, the features of the skeletal, renal, neuropsychologic, cardiovascular, and gastrointestinal manifestations of 'asymptomatic' primary hyperparathyroidism will be discussed. The considerable body of data that has emerged since the recognition of the new clinical profile of primary hyperparathyroidism has allowed a reconsideration of standards of care for this disease. These data were reviewed and incorporated into new clinical guidelines at the 2002 NIH workshop on asymptomatic primary hyperparathyroidism. These recommendations highlight both what is known about the disease, and important areas that need investigation. Continued interest in the skeletal, cardiovascular, and neuropsychiatric manifestations of the disease, and therapeutic trials of medical approaches for its management, will further refine our current understanding, and could lead to additional modifications in the approach to patients with this common endocrine disorder.
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Affiliation(s)
- Shonni J Silverberg
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Charopoulos I, Tournis S, Trovas G, Raptou P, Kaldrymides P, Skarandavos G, Katsalira K, Lyritis GP. Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women. J Clin Endocrinol Metab 2006; 91:1748-53. [PMID: 16492695 DOI: 10.1210/jc.2005-2102] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PH) is characterized by inappropriate PTH elevation with or without hypercalcemia. Bone disease involves catabolic action at cortical sites, whereas cancellous sites and geometry might be relatively preserved. OBJECTIVE Our objective was to examine the effect of PH on quantitative and qualitative bone characteristics using peripheral quantitative computed tomography at the tibia in postmenopausal women with PH and healthy controls. DESIGN AND SETTING We conducted a cross-sectional study at a tertiary referral center. PATIENTS Fifty-two postmenopausal women with PH and 56 healthy controls, comparable for age and anthropometric measures, participated. INTERVENTION There was no intervention. MAIN OUTCOME MEASURE We assessed volumetric bone mineral density (vBMD), bone mineral content (BMC), cortical thickness, cortical and trabecular area, peri- and endosteal circumference, and polar stress strength index assessed by peripheral quantitative computed tomography of the left tibia at 4% (cancellous), 14% (transition zone), and 38% (cortical) from the distal end. RESULTS At 4%, there was a significant decrease of trabecular BMC and vBMD (P < 0.001), effect particularly evident in hypercalcemic patients, whereas trabecular area was comparable. At 38%, cortical BMC (P < 0.01), vBMD (P < 0.01), area (P < 0.05), and thickness (P < 0.001) were reduced in the PH group, particularly in hypercalcemic patients. Endosteal circumference increased (P < 0.001), whereas periosteal circumference was comparable, indicating cancellization of cortical bone. At 14%, polar stress strength index was significantly decreased (P < 0.01) in hypercalcemic patients, indicating impairment of bone mechanical properties. CONCLUSIONS Normocalcemic PH is characterized by catabolic actions at both cortical and cancellous sites (38 and 4%, respectively), an effect accentuated in hypercalcemic patients. Cortical geometric properties are adversely affected even in normocalcemic patients, whereas trabecular properties are generally preserved.
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Affiliation(s)
- Ioannis Charopoulos
- Laboratory for Research of Musculoskeletal System, University of Athens, KAT Hospital, 14561 Athens, Greece
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Chappard C, Roux C, Laugier P, Paillard M, Houillier P. Bone status in primary hyperparathyroidism assessed by regional bone mineral density from the whole body scan and QUS imaging at calcaneus. Joint Bone Spine 2006; 73:86-94. [PMID: 15893950 DOI: 10.1016/j.jbspin.2004.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 08/01/2004] [Indexed: 11/29/2022]
Abstract
To assess the bone mineral density status in primary hyperparathyroidism (PHPT), we studied 64 females with PHPT and 17 healthy women. Regional BMD (arms, trunk, legs) from the whole body scan and conventional sites (lumbar spine, femur, radius) were assessed by DXA. Quantitative ultrasound (QUS) imaging measurements were performed at calcaneus. Sixteen women had history of renal lithiasis, 11 had low impact fracture and 37 women had neither renal lithiasis nor fracture. In the entire group, the mean Z-scores were significantly decreased at all sites (lumbar spine, femur, radius). In all clinical subgroups, the mean Z-scores were significantly decreased at radius. The mean Z-scores in premenopausal women were significantly decreased comparatively to postmenopausal women at lumbar spine and femur. In a group of PHPT females matched to controls for age and BMI, only BMD values at radius were lower in PHPT patients than in control (P < 0.03). However, from the whole body scan data, all sites but no trunk were significantly involved in PHPT patients (P < 0.04). Using QUS measurements at calcaneus, the BUA but not SOS in PHPT females was significantly lower (P = 0.03) than in controls. Our results suggest that low BMD at lumbar spine and femur is encountered preferentially in premenopausal women. The BMD decrease predominates at limbs in PHPT with presumably a gradient from proximal to distal part of the limbs. Indeed, the distal part of the limbs are the most affected areas in PHPT whatever the amount of cortical or trabecular bone.
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Affiliation(s)
- Christine Chappard
- Service de Physiologie et Radio-isotopes, Hôpital Européen Georges Pompidou, Paris, France.
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Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ. Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features. J Intern Med 2005; 257:6-17. [PMID: 15606372 DOI: 10.1111/j.1365-2796.2004.01422.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary hyperparathyroidism (PHPT) is characterized most commonly now as an asymptomatic disorder with hypercalcaemia and elevated levels of parathyroid hormone (PTH). The elevation in PTH is detected by both the standard immunoradiometric assays (IRMA) and a more recent IRMA that detects only the 1-84 full-length PTH molecule. The serum calcium concentration is usually <1 mg dL(-1) above normal. Recently, another variant of PHPT (normocalcaemic PHPT) has been described in which the serum calcium is normal but the serum PTH is elevated, in the absence of any secondary cause for PTH elevation. Although usually sporadic, PHPT also occurs in inherited syndromes. Skeletal manifestations are appreciated by densitometry showing a typical pattern in which cancellous bone of the lumbar spine is reasonably well preserved whilst the cortical bone of the distal third of the radius is preferentially reduced. Although reduced in incidence, renal stones remain the most common overt complication of PHPT. Other organs are theoretical targets of PHPT such as the neurobehavioural axis and the cardiovascular system. Vitamin D looms as an important determinant of the activity of the PHPT state. The 2002 NIH Workshop on asymptomatic PHPT has led to revised guidelines to help doctors determine who is best advised to have parathyroid surgery and who can be safely followed without surgery. New information about the natural history of PHPT in those who did not undergo surgery has helped to define more precisely who is at-risk for complications. At the NIH workshop, a number of items were highlighted for further investigation such as pharmacological approaches to controlling hypercalcaemia, elevated PTH levels and maintaining bone density.
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Affiliation(s)
- J P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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17
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Saleem TFM, Horwith M, Stack BC. Significance of primary hyperparathyroidism in the management of osteoporosis. Otolaryngol Clin North Am 2004; 37:751-61, viii-ix. [PMID: 15262513 DOI: 10.1016/j.otc.2004.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Primary hyperparathyroidism (HPT) has catabolic effects on cortical bone and anabolic effects on cancellous bone with overall deleterious effects on skeleton. Primary HPT is associated with increased fracture risk both at the cancellous bone-enriched spine and the cortical bone-enriched distal one third of the radius. This risk is reversed by parathyroidectomy.
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Abstract
Recent improvements in parathyroid imaging have led to renewed interest in the criteria for, and the surgical approach to, parathyroidectomy. It therefore seemed appropriate to review current evidence relating to the evaluation and management of primary hyperparathyroidism for those working within a general endocrine service. The recommendations are based on an electronic search spanning the past decade using the search terms hyperparathyroidism, management and parathyroidectomy/surgery, but we have also included key publications outside this period. The findings have been graded systematically (Appendix), according to the quality of the information available, to indicate the level of evidence on which they are based.
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Affiliation(s)
- M Davies
- Department of Medicine, Manschester Royal Infirmary, Royal Liverpool University Hospital, City Hospital, Nottingham, UK
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Bolanowski M, Pluskiewicz W. Quantitative ultrasound of the hand phalanges and calcaneus revealed skeletal abnormalities due to primary hyperparathyroidism: a case report. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:265-269. [PMID: 11937290 DOI: 10.1016/s0301-5629(01)00487-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Primary hyperparathyroidism (PHPT) is a common disease causing bone loss in elderly patients. We report a case study of a 36-year-old woman with PHPT. Quantitative ultrasound (QUS) assessment of the phalanges and calcaneus revealed significantly lower than normal values for age. This observation was confirmed by measuring bone mineral density in different skeletal sites using dual-energy X-ray absorptiometry (DXA). Subsequent parathyroid adenoma surgery normalized calcium metabolism, resulting in a progressive increase of BMD and ultrasound (US) parameters. This report has shown an ability of peripheral QUS examinations (phalanges and calcaneus) in early detection of bone alterations caused by PHPT in a young woman. Skeletal changes after surgery could be evaluated by QUS in a similar manner to that used in DXA.
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Affiliation(s)
- Marek Bolanowski
- Department of Endocrinology and Diabetology, Wroclaw Medical University, Poland.
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20
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Pedrera JD, López MJ, Canal ML, Costa C, Mañas P, Hernández ER, Rico H. Quantitative phalangeal bone ultrasound is normal after long-term gluten-free diet in young coeliac patients. Eur J Gastroenterol Hepatol 2001; 13:1169-73. [PMID: 11711772 DOI: 10.1097/00042737-200110000-00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS To determine bone mass using quantitative phalangeal bone ultrasound in young coeliac patients after a long-term gluten-free diet. SUBJECTS A total of 99 patients with coeliac disease (CD) (52 girls, mean age 15.5 +/- 9.7 years; 47 boys, mean age 14.4 +/- 8.4 years) and 44 healthy subjects matched for age, weight and height (26 girls, mean age 18.4 +/- 9.9 years; 18 boys, mean age 16.3 +/- 11.2 years) were included in the study. METHODS Bone status was assessed using an ultrasound device that measures amplitude-dependent speed of sound (Ad-SoS) in metres per second. Measurements were made on the phalanges (II-V) of the non-dominant hand, and an average value was computed. Nutrient intake was assessed using a 7-day record. RESULTS Analysis of variance (ANOVA) and the unpaired t-test showed that the intake of phosphates (P < 0.05), proteins, fat and carbohydrates (P < 0.005 in all) was higher in patients than in controls. No significant difference in Ad-SoS was found between patients and controls (95% CI -10.9 to 60.6) in the overall group, in girls or boys, or in patients following a gluten-free diet strictly or partially. In the patients, only age (beta 4.01, 95% CI 1.84-6.16, P < 0.0005) and weight (beta 2.62, 95% CI 1.53-3.70, P < 0.0001) showed a significant positive relation with Ad-SoS. CONCLUSIONS In patients with CD, gluten-free diet and increased nutritional intake were accompanied by normal bone mass values as determined by ultrasound on phalanges.
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Affiliation(s)
- J D Pedrera
- Department of Nursing, University of Extremadura, Spain
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Patel S, Kwan JT, McCloskey E, McGee G, Thomas G, Johnson D, Wills R, Ogunremi L, Barron J. Prevalence and causes of low bone density and fractures in kidney transplant patients. J Bone Miner Res 2001; 16:1863-70. [PMID: 11585351 DOI: 10.1359/jbmr.2001.16.10.1863] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Osteoporosis is known to occur in patients with kidney transplants, but limited information is available about the prevalence and causes of this complication. We asked all 330 patients with kidney transplants in our unit to participate in this study of whom 165 (50%) agreed to do so. The characteristics of the participating patients were similar to the remaining 165 nonparticipants. Seventy of 165 (42%) of the participants were women of whom 40 were postmenopausal in contrast to the men of whom only one was hypogonadal. Bone mineral density (BMD) was significantly reduced at the radius (Z score, -1.5) and femoral neck (Z score, -0.7), but the lumbar spine was normal. BMD was lower in women than men at all skeletal sites. Osteoporosis was found in 10-44% and osteopenia was found in 35-50% of women depending on the site. BMD was related inversely to time since transplantation and cumulative prednisolone dose. Twenty-seven of the 165 (16%) patients had either vertebral deformities or a history of a low trauma fracture after transplantation. This fracture group consisted of 10/27 (37%) men and 17/27 (63%) women, of whom 14 were postmenopausal. Fracture patients tended to be older and have a longer duration of renal failure, dialysis, transplantation, greater cumulative steroid dose, and higher bone resorption markers than the nonfracture group. No differences were found for cumulative doses of cyclosporin or tacrolimus. Logistic regression showed that only duration of dialysis and time since transplantation significantly increased fracture risk, with odds ratio (OR) for each year of dialysis or transplantation being 1.21 (CI, 1.00-1.48) and 1.14 (CI, 1.05-1.23), respectively. These data show that low bone density and fractures are common in patients with kidney transplant and are determined by both pre- and posttransplant variables. Fracture risk was greatest in women, particularly if they were postmenopausal and we recommend that this subgroup is targeted for assessment and treatment.
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Affiliation(s)
- S Patel
- Department of Rheumatology, St. Helier Hospital, Epsom and St. Helier NHS Trust, Carshalton, Surrey, United Kingdom
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Zhou H, Shen V, Dempster DW, Lindsay R. Continuous parathyroid hormone and estrogen administration increases vertebral cancellous bone volume and cortical width in the estrogen-deficient rat. J Bone Miner Res 2001; 16:1300-7. [PMID: 11450706 DOI: 10.1359/jbmr.2001.16.7.1300] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Generally, it is believed that intermittent administration of parathyroid hormone (PTH) has an anabolic effect on the skeleton, whereas continuous administration is catabolic. However, there is evidence that continuous exposure to PTH may have an anabolic effect, for example, in patients with mild primary hyperparathyroidism (PHPT). The possibility of delivering PTH continuously may have important implications for the treatment of osteoporosis. Furthermore, estrogen treatment may be useful in the medical management of PHPT. Therefore, we examined the skeletal effects of continuous administration of PTH, with or without estrogen, in the estrogen-deficient rat with established osteopenia. Forty 7-month-old SD rats were divided into four ovariectomy (OVX) groups and one sham-operated group. Eight weeks post-OVX, three groups received subcutaneous implants of Alzet mini pumps loaded with PTH(1-34) (30 microg/kg per day), 17beta-estradiol (10 microg/kg per day) pellet, or both PTH and 17beta-estradiol separately for 4 weeks. OVX and sham control groups were given the mini pumps loaded with vehicle. Two doses of calcein (10 mg/kg) were given subcutaneously to all rats 2 days and 8 days before death. Histomorphometry was performed on cancellous and cortical bone of the fourth lumbar vertebra. At 3 months, post-OVX rats displayed bone loss with high bone turnover. Estrogen reversed OVX-mediated high turnover without restoring cancellous bone volume (BV/TV). PTH infusion further increased bone turnover and partially restored BV/TV. However, PTH infusion increased cortical porosity. Estrogen inhibited PTH-mediated cancellous bone resorption and substantially increased BV/TV above sham control. The combined treatment was associated with a significant increase in peritrabecular fibrosis and woven bone formation. The combined treatment of PTH infusion and estrogen replacement enhanced cortical width but estrogen did not prevent the PTH-induced cortical tunneling. We conclude that continuous administration of PTH and estrogen increases cortical porosity but has substantial beneficial effects on vertebral cancellous bone volume and cortical width in OVX rats.
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Affiliation(s)
- H Zhou
- Helen Hayes Hospital, New York State Health Department, West Haverstraw 10993-1195, USA
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23
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Abstract
Traditional bone involvement, such as osteoitis fibrosa, has become very rare (< 1%) in primary hyperparathyroidism (PHPT); nevertheless, fractures seem more frequent than in controls, with a predilection for fractures of the distal extremity of the radius, pelvis, ribs and vertebrae, and a relative modest incidence of fractures of the upper extremity of the femur. Histo-morphometric studies have stressed a discrepancy between cortical and trabecular bone with an increase of bone remodeling. The cortical width is constantly diminished and the cortical porosity is increased whereas trabecular volume is normal and micro-architecture preserved. Bone mineral density (BMD) allows an early diagnosis of bone disease and takes a growing place in the management of patients. Since the consensus conference in 1991, the measurement of BMD has been incorporated in the surgical decision with a threshold: Z-score < -2. The demineralisation predominates on sites rich in cortical bone (1/3 proximal of the distal radius); the radius, which was the first site evaluated for technical reasons, is also the most discriminating one. Spine demineralisation is met in more severe forms and BMD measurement of the whole body is promising but requires more studies. In the absence of a radical processing, moderate forms remain stable, whereas more severe forms have a tendency to deteriorate. The evaluation of spine and femoral BMD is useful for the follow-up because the bone gain after parathyroidectomy is significant early on at these sites (rich in trabecular bone with high bone turnover), whereas the BMD of radius is relatively stable.
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Affiliation(s)
- C Chappard
- Service de Physiologie et de radio-isotope, h pital Georges Pompidou, Paris, France.
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Nielsen SP. The metacarpal index revisited: a brief overview. J Clin Densitom 2001; 4:199-207. [PMID: 11740061 DOI: 10.1385/jcd:4:3:199] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2000] [Revised: 04/23/2001] [Accepted: 04/24/2001] [Indexed: 11/11/2022]
Abstract
Metacarpal index (MCI) is combined cortical thickness (both sides)) normalized with regard to outer bone diameter of the measuring site, the midshaft of the second metacarpal, or the three midmetacarpals of both hands. MCI is reduced with age, particularly in postmenopausal women. It correlates with axial bone mass in group studies. Measurement of the MCI in its modern version, digital X-ray radiogrammetry (DXR), requires only a plain analog radiograph, a PC, a film scanner, and reliable software. MCI can be used diagnostically and longitudinally for monitoring changes. MCI measured with DXR has few problems regarding accuracy and precision errors, and MCI is presently regaining lost territories among tests for quantification of bone mass and bone strength. It can be measured inexpensively and swiftly. MCI and other geometrical variables of bone can be measured on old radiographs, thus enabling estimation of cortical bone loss from the time of earlier recordings.
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Affiliation(s)
- S P Nielsen
- The Bone Research Group, Department of Clinical Physiology, Hillerød Hospital, DK-3400 Hillerød, Denmark.
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Cormier C, Souberbielle JC, Kindermans C. Hyperparathyroidism: the limits of surgery in cases of bone or cardiovascular involvement. Curr Opin Rheumatol 2000; 12:349-53. [PMID: 10910190 DOI: 10.1097/00002281-200007000-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In primary hyperparathyroidism (PHPT), asymptomatic bone disease can be detected by bone densitometry. The bone mineral density is about 10% lower than normal control values, especially in the cortical radius. Without parathyroidectomy, bone mineral density is frequently stable, but a few patients, mostly postmenopausal women, have a significant decrease. Histology shows maintenance of trabecular connectivity but with an increase in cortical porosity. After parathyroidectomy, bone mineral density increases, particularly at the lumbar spine and femoral neck, and the benefit persists after 10 years. The fracture risk is controversial but risk of trabecular bone fracture may be higher than that for controls. The impact of PHPT on survival is also controversial, but highest quartile of serum calcium, osteoporosis, old age, and low lean mass are each associated with a death risk. There is also a debate about the criteria for distinguishing between asymptomatic and symptomatic PHPT and about the bone mineral density threshold that should be used as a basis to recommend surgery. The rate of progression of PHPT is slow but in some cases bone loss progresses, justifying bone mineral density follow-up. The frequency of inadequate follow-up and the cost of nonoperative follow-up are in favor of recommending surgery. With broader indications for surgery, it is mandatory to improve the biochemical diagnosis of PHPT.
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Affiliation(s)
- C Cormier
- Laboratoire de Physiologie, Hôpital Necker Enfants Malades, APHP Paris, France.
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Muñoz-Torres M, Ventosa Viñas M, Mezquita Raya P, Luna V, López Rodríguez F, Becerra D, Quesada Charneco M, Escobar Jiménez F, Jiménez Moleón J. [Usefulness of bone densitometry in the evaluation of primary hyperparathyroidism]. Med Clin (Barc) 2000; 114:521-4. [PMID: 10846662 DOI: 10.1016/s0025-7753(00)71352-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years, the clinical profile of primary hyperparathyroidism (PH) is predominantly characterized by mild or asymptomatic forms. In this context, the effects of the PH on bone metabolism reach a growing importance in the adoption of therapeutic decisions. PATIENTS AND METHODS 116 patients with PH were studied, 95 women (25 premenopausal, 70 postmenopausal) and 21 males. In all cases parathyroidectomy criteria were evaluated. Bone mineral density (BMD) was determined in 71 patients in lumbar spine (LS) and femoral neck by dual-X-Ray absorptiometry (DXA) and the influence of this measurement in the decision of surgical treatment was analyzed. RESULTS The patients with PH showed a significant reduction of BMD at all sites (p < 0.001) and 71.8% met osteoporosis densitometric criteria. The most frequent parathyroidectomy criteria was the presence of specific clinical manifestations (51.7%) followed by decrease of the BMD in LS (49.3%). The probability of meeting criteria for surgical treatment was significantly higher in patients in which BMD was measured (odds ratio: 3.09 [1.03-9.22]; p = 0.036). CONCLUSIONS In its current presentation, PH presents a significant decrease of bone mass. The systematic performance of bone densitometry has a decisive influence in its appropriate management.
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Affiliation(s)
- M Muñoz-Torres
- Servicio de Endocrinología y Nutrición (Unidad de Metabolismo Oseo), Hospital Clínico San Cecilio, Granada.
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Adami S, Viapiana O, Corallo F. Treatment induced changes of bone density and relative risk of vertebral fracture. J Endocrinol Invest 1999; 22:609-15. [PMID: 10532248 DOI: 10.1007/bf03343618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S Adami
- Riabilitazione Reumatologica, Ospedale di Valeggio, University of Verona, Italy.
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Lundgren E. Primary hyperparathyroidism of postmenopausal women. Prospective population-based case-control analysis on prevalence, clinical findings and treatment. Minireview based on a doctoral thesis. Ups J Med Sci 1999; 104:87-130. [PMID: 10422215 DOI: 10.3109/03009739909178956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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