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Current Osteoporosis Reports

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01-06-2020 | Hyperparathyroidism | Epidemiology and Pathophysiology (G El-Hajj Fuleihan and D Shoback, Section Editors)

Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective

Authors: Lars Rejnmark, Henriette Ejlsmark-Svensson

Published in: Current Osteoporosis Reports | Issue 3/2020

Abstract

Purpose of Review

Hyperparathyroidism may be due to an autonomous hypersecretion of parathyroid hormone (PTH) or occurs in response to a number of physiological stimuli. A number of recent findings have provided new insights into the importance of the calcium-parathyroid-vitamin D axis to bone in normal physiology and pathological conditions.

Recent Findings

PTH is known to affect bone microarchitecture with different effects on cortical and trabecular bone compartments. In trabecular bone, PTH may exert anabolic effects, whereas PTH promotes bone resorption in cortical bone. Vertebral fractures are prevalent in primary hyperparathyroidism (PHPT), and patients seem to fracture at higher values of bone mineral density (BMD) than patients with osteoporosis. This may be explained by changes in bone microarchitecture, which cannot be detected by measuring BMD. Even in mild PHPT, bone seems to benefit from parathyroidectomy. In secondary hyperparathyroidism, bone seems much more susceptible to fracture with insufficient levels of vitamin D compared with a replete vitamin status. If elevated PTH levels cannot be explained by conditions known to cause secondary hyperparathyroidism, the condition is termed normocalcemic PHPT, which also has been associated with an increased risk of fractures.

Summary

Hyperparathyroidism is harmful to bone, which is why it is of importance to normalize PTH levels either by parathyroidectomy in PHPT or by counteracting conditions known to increase PTH in secondary hyperparathyroidism.

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Title: Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective
Authors: Lars Rejnmark
Henriette Ejlsmark-Svensson
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Hyperparathyroidism
Parathyroidectomy
Parathyroidectomy
Hypercalcemia
Published in: Current Osteoporosis Reports / Issue 3/2020
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI: https://doi.org/10.1007/s11914-020-00574-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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