Top

Osteoporosis International

Published in:

01-07-2014 | Short Communication

Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism

Authors: E. Koumakis, J.-C. Souberbielle, J. Payet, E. Sarfati, D. Borderie, A. Kahan, C. Cormier

Published in: Osteoporosis International | Issue 7/2014

Abstract

Summary

In this study, we show that successful parathyroidectomy is followed at 1 year by a significant individual bone mineral density (BMD) gain in nearly half of normocalcemic PHPT patients with reduced bone mass. Alkaline phosphatase levels above median were identified as an independent predictor of individual BMD gain in normocalcemic PHPT patients.

Introduction

The aims of this study were to assess bone mineral density (BMD) gains after parathyroidectomy (PTX) in normocalcemic primary hyperparathyroidism (PHPT) at the individual level and to identify predictors of BMD gain after PTX in this context.

Methods

Longitudinal cohort study of 55 PHPT patients referred for low bone mass and mild abnormalities of calcium/phosphorus metabolism, and successfully treated by PTX. BMD gain at 1 year was considered significant if ≥0.030 g/cm² at one site or more, without any equivalent BMD loss at another site. A logistic regression analysis was performed to identify predictive factors of individual BMD gain.

Results

Among the 55 PHPT patients included, 29 patients with hypercalcemia, 36 patients with normocalcemic PHPT, defined by normal pre-PTX serum total (albumin-corrected) calcium (tCa), including 15 patients with normal ionized calcium (iCa), were identified. At 1 year of PTX, an individual BMD gain was observed in 73.7 % of hypercalcemic, 44.4 % of normocalcemic, and 46 % of PHPT patients with both normal tCa and iCa. Site-specific BMD gains were most important at the spine and hip in all subgroups including patients with normal iCa. Alkaline phosphatase activity above median, which reflects high bone turnover, was predictive of individual BMD gain, both in the overall cohort (OR = 4.9, 95 % CI 1.3–18.9), and in the normocalcemic group: OR = 8.4, 95 % CI 1.4–56.6.

Conclusions

Successful PTX is followed at 1 year by a significant individual BMD gain in nearly half of normocalcemic PHPT patients with osteoporosis. ALP levels above median could contribute to the therapeutic decision in this context.

Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR (2009) Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94(2):351–365PubMedCrossRef

Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ (2007) Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 92(8):3001–3005PubMedCrossRef

Cusano NE, Maalouf NM, Wang PY, Zhang C, Cremers SC, Haney EM, Bauer DC, Orwoll ES, Bilezikian JP (2013) Normocalcemic hyperparathyroidism and hypoparathyroidism in two community-based nonreferral populations. J Clin Endocrinol Metab 98:2734–2741PubMedCrossRef

Silverberg SJ, Bilezikian JP (2003) “Incipient” primary hyperparathyroidism: a “forme fruste” of an old disease. J Clin Endocrinol Metab 88:5348–5352PubMedCrossRef

Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341:1249–1255PubMedCrossRef

Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93(9):3462–3470PubMedCentralPubMedCrossRef

Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 4:283–291PubMedCrossRef

Silverberg SJ, Gartenberg F, Jacobs TP, Shane E, Siris E, Staron RB, McMahon DJ, Bilezikian JP (1995) Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab 80:729–734PubMed

Christiansen P, Steiniche T, Brixen K, Hessov I, Melsen F, Heickendorff L, Mosekilde L (1999) Primary hyperparathyroidism: effect of parathyroidectomy on regional bone mineral density in Danish patients: a three-year follow-up study. Bone 25(5):589–595PubMedCrossRef

10.

Christiansen P, Steiniche T, Brixen K, Hessov I, Melsen F, Heickendorff L, Mosekilde L (1999) Primary hyperparathyroidism: short-term changes in bone remodeling and bone mineral density following parathyroidectomy. Bone 25(2):237–244PubMedCrossRef

11.

Moosgaard B, Christensen SE, Vestergaard P, Heickendorff L, Christiansen P, Mosekilde L (2008) Vitamin D metabolites and skeletal consequences in primary hyperparathyroidism. Clin Endocrinol 68(5):707–715CrossRef

12.

Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T (2007) Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab 92(5):1687–1692PubMedCrossRef

13.

Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89(11):5415–5422PubMedCrossRef

14.

Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92(8):3114–3121PubMedCrossRef

15.

Koumakis E, Souberbielle J-C, Sarfati E (2013) Bone mineral density evolution after successful parathyroidectomy in patients with normocalcemic primary hyperparathyroidism. J Clin Endocrinol Metab 98:3213–3220PubMedCrossRef

16.

Rosen CJ, Hochberg MC, Bonnick SL, McClung M, Miller P, Broy S, Kagan R, Chen E, Petruschke RA, Thompson DE, de Papp AE (2005) Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study. J Bone Miner Res 20:141–151PubMedCrossRef

17.

Leppla DC, Snyder W, Pak CY (1982) Sequential changes in bone density before and after parathyroidectomy in primary hyperparathyroidism. Invest Radiol 17:604–606PubMedCrossRef

18.

Elvius M, Lagrelius A, Nygren A, Alveryd A, Christensson TA, Nordenstrom J (1995) Seventeen year follow-up study of bone mass in patients with mild asymptomatic hyperparathyroidism some of whom were operated on. Eur J Surg 161:863–869PubMed

19.

Nakaoka D, Sugimoto T, Kobayashi T (2000) Prediction of bone mass change after parathyroidectomy in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 85:1901–1907PubMed

20.

Strømme JH, Rustad P, Steensland H, Theodorsen L, Urdal P (2004) Reference intervals for eight enzymes in blood of adult females and males measured in accordance with the international Federation of Clinical Chemistry reference system at 37°C: part of the Nordic Reference Interval Project. Scand J Clin Lab Invest 64:371–384PubMedCrossRef

Title: Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism
Authors: E. Koumakis
J.-C. Souberbielle
J. Payet
E. Sarfati
D. Borderie
A. Kahan
C. Cormier
Publication date: 01-07-2014
Publisher: Springer London
Published in: Osteoporosis International / Issue 7/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-014-2689-2

At a glance: The STEP trials

Springer Medicine

Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2014

Higher serum uric acid as a protective factor against incident osteoporotic fractures in Korean men: a longitudinal study using the National Claim Registry

Calcium and vitamin D intake maintained from preovariectomy independently affect calcium metabolism and bone properties in Sprague Dawley rats

External auditory canal and middle ear cholesteatoma and osteonecrosis in bisphosphonate-treated osteoporosis patients: a Danish national register-based cohort study and literature review

The impact of educational interventions on modifiable risk factors for osteoporosis after a fragility fracture

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

Vitamin D receptor variability and physical activity are jointly associated with low handgrip strength and osteoporosis in community-dwelling elderly people in Taiwan: the Taichung Community Health Study for Elders (TCHS-E)