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01-01-2013 | Original Article

BMD improvements after operation for primary hyperparathyroidism

Authors: Lars Rolighed, Peter Vestergaard, Lene Heickendorff, Tanja Sikjaer, Lars Rejnmark, Leif Mosekilde, Peer Christiansen

Published in: Langenbeck's Archives of Surgery | Issue 1/2013

Abstract

Purpose

This study aims to quantify bone mineral density (BMD) changes following surgery in patients with primary hyperparathyroidism (PHPT) and to assess their relationship with clinical and biochemical variables.

Methods

A historic cohort of 236 PHPT patients with DXA scans pre- and 1-year postoperatively, clinical data, and biochemical data was analyzed.

Results

The mean age was 60 years (range 19–86) and 81 % of the patients were women. A significant postoperative 2.6 % (95 % CI, 2.1; 3.1) increase in lumbar spine BMD was seen. The increase in BMD was positively associated with preoperative plasma PTH (p = 0.002), Ca²⁺ (p < 0.001), and alkaline phosphatase (p = 0.014). Hip BMD increased 1.5 % (1.1; 1.9). The increase in BMD was positively associated with preoperative plasma PTH (p = 0.005) and Ca²⁺ (p < 0.001) and inversely associated with plasma creatinine (p = 0.004) and age (p = 0.018). Total forearm BMD did not change significantly (−0.2 % (−0.5; 0.1)). An increase in forearm BMD was seen in 38 % of all patients, and the changes were positively associated with plasma PTH (p < 0.001) and Ca²⁺ (p = 0.009). In all 91 patients with mild PHPT (plasma Ca²⁺ < 1.45 mmol/l), there was a significant postoperative increase in spine BMD (1.9 % (1.2; 2.7)) and in hip BMD (1.0 % (0.4; 1.6)), but not in the forearm BMD (−0.3 % (−0.7; 0.2)). The postoperative BMD gain was higher in the hip and forearm in patients operated for adenomas compared with patients treated for hyperplasia.

Conclusions

We found significant postoperative BMD improvements both at the hip and the spine. BMD improvements were also significant in mild cases. At all scan sites, there were positive associations between preoperative plasma PTH levels and postoperative BMD increases. The measured BMD changes may mainly be due to a decrease in PTH-induced bone turnover with refilling of the remodeling space.

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Title: BMD improvements after operation for primary hyperparathyroidism
Authors: Lars Rolighed
Peter Vestergaard
Lene Heickendorff
Tanja Sikjaer
Lars Rejnmark
Leif Mosekilde
Peer Christiansen
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1026-5

At a glance: The STEP trials

Springer Medicine

BMD improvements after operation for primary hyperparathyroidism

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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