Changes in bone mineral density after surgical intervention for primary hyperparathyroidism
ABSTRACT BACKGROUND: Patients with primary hyperparathyroidism often lack classic symptoms but can have reductions in bone mineral density and increased fracture risk. We sought to determine bone mineral density improvement after successful surgery and associated factors. METHODS: A review of patients with osteopenia or osteoporosis with curative parathyroidectomy and both pre- and postoperative dual-energy X-ray absorptiometry bone mineral density scans was conducted. We compared patients with declining (<0%), moderate improvement (0.1-5%), and significant improvement (>5%) on dual-energy X-ray absorptiometry bone mineral density scans. RESULTS: We identified 420 patients who underwent a dual-energy X-ray absorptiometry bone mineral density scan preoperatively and within 36 months postoperatively. At the most affected site, 38% had significant improvement, 31% moderate improvement, and 31% declining bone mineral density. Patients who significantly improved were younger (P = .01), had lesser preoperative dual-energy X-ray absorptiometry (P = .001), and had greater preoperative levels of parathyroid hormone (P = .04), serum calcium (P = .03), and preoperative urinary calcium. There was no difference in outcomes between sex and with preoperative bisphosphonate use. Average hip and spine bone mineral density had similar responses to surgery. CONCLUSION: Bone mineral density improves in up to 75% of patients after curative parathyroidectomy for primary hyperparathyroidism. The hip and lumbar spine responded similarly. Younger patients and those with severe primary hyperparathyroidism may derive the most skeletal benefits from parathyroidectomy, but the uniform positive response supports parathyroidectomy in patients with osteoporosis and possibly osteopenia.
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ABSTRACT: Patients with primary hyperparathyroidism (PHPT) have higher bone turnover, lower bone mineral density and an increased risk of fractures. They also have a high incidence of low vitamin D levels (25-OH-vitamin D < 50 nmol/l) that could worsen the negative effect on the bone. In this double-blinded clinical trial, 150 patients with PHPT were randomized, after successful parathyroidectomy (PTX), to one-year daily treatment with either cholecalciferol 1600 IU and calcium carbonate 1000 mg (D +) or calcium carbonate alone (D -). Bone mineral density (BMD) was measured in the lumbar spine, femoral neck, total hip, distal and 33% radius using dual X-ray absorptiometry (DXA) before surgery and after one year of study medication. Median age was 60 years (30-80 years) and there were 119 (79%) women and 31 (21%) men. 76% had 25-OH-D < 50 nmol/l before PTX. 50% had persistent elevated PTH 6 weeks after PTX. A similar increase in BMD in the lumbar spine, femoral neck and total hip was observed in both groups (D + : 3.6%, 3.2% and 2.7%, p < 0.001; D-: 3.0%, 2.3% and 2.1%, p < 0.001). Patients with vitamin D supplementation also increased their BMD in distal radius (2.0% (-1.7 - 5.4), p = 0.013). The changes in BMD, especially in the hips, were correlated to the baseline concentrations of PTH, ionized calcium and bone markers (p < 0.001). Except for the increase in distal radius BMD, a benefit from vitamin D substitution was observed among patients with a persistent postoperative PTH elevation, who also improved their BMD at 33% radius and radius UD (p < 0.05). In conclusion, except for a minor improvement of radius BMD, our data show no beneficial effect on BMD or bone turnover markers of vitamin D supplementation after PTX. Preoperative PTH seems to have the strongest association with improvement in BMD.Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 04/2014; 29(4). DOI:10.1002/jbmr.2102 · 6.59 Impact Factor
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ABSTRACT: Primary hyperparathyroidism (PHPT) results in increased bone turnover, resulting in bone mineral density (BMD) reduction and a predisposition towards fractures. Parathyroidectomy (PTX) is the only definitive cure. The primary goals of this study were to investigate the impact of PTX on BMD in patients with PHPT and to identify factors associated with post-operative BMD improvement using a multivariate model. Between 1999 and 2010, a total of 757 patients underwent PTX for treatment of PHPT; 123 patients had both a pre- and a post-operative dual-energy X-ray absorptiometry (DEXA) scan. A prospective database was queried to obtain information about patient demographics, medications, comorbidities, and pre- and post-operative laboratory values. A Cox regression model was used to stratify patients and to identify factors that independently predict BMD response following PTX in this patient population. Overall, mean percent change in BMD was +12.31 % at the spine, +8.9 % at the femoral neck (FN), and +8.5 % at the hip, with a mean follow-up of 2.3 ± 1.5 years. A total of 101 (82.1 %) patients had BMD improvement at their worst pre-operative site. In patients who improved, 69.9 % (n = 86) had >5 % increase. Factors associated with BMD improvement at the worst pre-operative site were as follows: male gender (hazard ratio [HR] 2.29; 95 % confidence interval [CI] 1.54-4.21); pre-operative BMD with T-score less than -2.0 (HR 1.89; 95 % CI 1.11-2.39); age <55 years (HR 1.74; 95 % CI 1.14-2.25); BMD DEXA scan at >2.5 years post-operatively (HR 1.71; 95 % CI 1.09-2.17); history of previous fracture (HR 1.24; 95 % CI 1.05-1.92); and private insurance (HR 1.18; 95 % CI 1.06-2.1). The use of bisphosphonates, estrogens, vitamin D supplementation, or tobacco; obesity; history of previous PTX, serum calcium or parathyroid hormone levels were not independently associated with post-operative BMD improvement. Osteoporosis is one of the established National Institutes of Health criteria for PTX in asymptomatic patients with PHPT, but BMD improvement is not consistently seen during the post-operative period. Gender, age, more severe pre-operative bone disease, and insurance status were all predictors for greater BMD improvement following PTX. Further studies with a rigorous post-operative BMD regimen are needed in order to validate these results.World Journal of Surgery 04/2014; 38(6). DOI:10.1007/s00268-014-2555-6 · 2.35 Impact Factor
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ABSTRACT: The goal of the study is to determine the relationship between irritable bowel syndrome (IBS) and osteoporosis in Taiwan. We collected data from the National Health Insurance (NHI) program in Taiwan. The sample in this study consisted of 31,892 patients enrolled from 2000 to 2009 and diagnosed by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). We divided the sample into 2 cohorts based on whether they had IBS, and formed subgroups based on age, sex, enrolment year, and enrolment month. Age and gender did not differ statistically among the 2 cohorts. Results show that IBS is more correlated with urbanization and the occupation of business. The IBS cohort had a higher incidence of osteoporosis than the non-IBS cohort (6.90 vs 4.15 per 1000 person-years; HR=1.65, 955 CI=1.54-1.77). Female patients aged 40-59years had the highest risk of developing osteoporosis (HR=4.42, 95% CI=3.37-5.79 in the IBS cohort; HR=4.41, 95% CI=3.67-5.29 in the non-IBS cohort, respectively). In IBS patients less than 40years of age, female patients had a significant 2.18-fold greater risk of developing osteoporosis than male patients (HR=2.18, 95% CI=1.09-4.38). IBS is a risk factor for osteoporosis in Taiwan.European Journal of Internal Medicine 10/2013; DOI:10.1016/j.ejim.2013.10.009 · 2.30 Impact Factor