DOES BASELINE PTH INFLUENCE RECOVERY OF BONE MINERAL DENSITY, TRABECULAR BONE SCORE AND BONE TURNOVER MARKERS? A PROSPECTIVE STUDY FOLLOWING CURATIVE PARATHYROIDECTOMY IN PRIMARY HYPERPARATHYROIDISM

2020 ◽  
Vol 26 (12) ◽  
pp. 1442-1450
Author(s):  
Shrinath Shetty ◽  
Kripa Elizabeth Cherian ◽  
Sahana Shetty ◽  
Nitin Kapoor ◽  
Felix K. Jebasingh ◽  
...  

Objective: This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery. Methods: This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery. Results: Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638 ± 0.093 versus 0.698 ± 0.041 g/cm2; P = .01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH. Conclusion: The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score

2019 ◽  
Vol 51 (03) ◽  
pp. 186-190 ◽  
Author(s):  
Gonzalo Miguel ◽  
Federico Carranza ◽  
Juan Rodríguez ◽  
Mercedes Ramos ◽  
David Pablos ◽  
...  

AbstractFollowing a parathyroidectomy there is a bone mineral density (BMD) improvement in patients with primary hyperparathyroidism. However, data of bone microarchitecture are scarce. Trabecular bone score (TBS) estimates bone microarchitecture and could provide valuable information in those patients. The aim of this study is to assess TBS changes 2 years after successful surgery in a group of patients with primary hyperparathyroidism and correlate these results with changes in BMD and bone turnover markers. This is a prospective study including 32 patients. In all participants BMD and TBS were measured, before and 24 months after surgery. Biochemical data: serum calcium, PTH, 25-OH-vitamin D, beta-crosslaps, bone alkaline phosphatase, and osteocalcin. 25 female and 7 male patients, mean age 64.6±12.4 years, were included in the study. At baseline, BMD was low at: lumbar spine (T-score −2.19±1.31), total hip (−1.33±1.12), femoral neck (−1.75±0.84), and distal one-third radius (−2.74±1.68). Baseline TBS showed partially degraded microarchitecture (1.180±0.130). After parathyroidectomy lumbar spine BMD increased significantly (5.3±13.0%, p<0.05), as well as total hip (3.8±8.8%, p<0.05). There was an increase in TBS, but this was not significant. There was a correlation between TBS and BAP at baseline (rs=0.73; p<0.01) and TBS and BAP 2 years after surgery (rs=0.57, p<0.05). Although bone density improves 2 years after surgery in patients with primary hyperparathyroidism and there is a restoration of bone turnover markers, TBS is not completely restored. These results remark the necessity of longer periods of study, to confirm if bone microarchitecture could be completely restored after surgery.


2017 ◽  
Vol 99 (7) ◽  
pp. 559-562 ◽  
Author(s):  
P Rajeev ◽  
A Movseysan ◽  
A Baharani

Introduction Involvement of the bone is common in primary hyperparathyroidism. The aim of the study was to assess bone turnover markers in response to surgery for primary hyperparathyroidism. Methods This was a retrospective study of patients diagnosed and treated for parathyroid disease between 2005 and 2012. Interventions studied were surgery and medical treatment. The main outcome measures studied were serum levels of calcium, intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase, N-terminal cross-linking propeptide of type 1 procollagen (P1NP) and C-terminal cross-linking telopeptides of type I collagen (CTX), both pre- and postoperatively at 6 months and 1 year; bone mineral density (at the spine and hip assessed by dual-energy x-ray absorptiometry after 1 year of treatment. Results A total of 122 (110 female, 12 male) patients (age range 25–91 years) underwent treatment for parathyroid disease during the study period; 30 patients were treated conservatively and 92 proceeded to surgery following localisation studies. Following surgical intervention, P1NP dropped significantly from a mean of 64.68 ng/ml (standard deviation, SD ± 68.07 ng/ml) preoperatively to 26.37 ng/ml (SD ± 20.94 ng/ml) and CTX from 0.69 pg/ml (SD ± 0.44 pg/ml) to 0.15 pg/ml (SD ± 0.16 pg/ml) at 6–12 months (P < 0.0001). This change was reflected in improvement in bone mineral density (T scores) of the hip and spine by 43% (P < 0.03) and 38% (P < 0.01), respectively, following surgery. In patients treated conservatively (n = 30), there was no improvement either in the bone turnover markers or bone densitometry scans. Conclusions Surgery improves bone density in patients with parathyroid disease. Improvement in serum bone turnover markers is seen following parathyroidectomy. The association with bone density needs further evaluation in larger studies.


2014 ◽  
Author(s):  
Mingo Dominguez Maria Luisa de ◽  
Sonsoles Guadalix Iglesias ◽  
Maria Begona Lopez Alvarez ◽  
Guillermo Martinez Diaz-Guerra ◽  
Federico Hawkins Carranza

2019 ◽  
Vol 17 (4) ◽  
pp. 102-106
Author(s):  
M. Yu. Smetanin ◽  
◽  
S. Yu. Nurgalieva ◽  
N. Yu. Kononova ◽  
L. T. Pimenov ◽  
...  

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
A. Sánchez ◽  
L. R. Brun ◽  
H. Salerni ◽  
P. R. Costanzo ◽  
D. González ◽  
...  

The aim of this study was to evaluate the effect of denosumab (Dmab) on bone mineral density (BMD) and bone turnover markers after 1 year of treatment. Additionally, the effect of Dmab in bisphosphonate-naïve patients (BP-naïve) compared to patients previously treated with bisphosphonates (BP-prior) was analyzed. This retrospective study included 425 postmenopausal women treated with Dmab for 1 year in clinical practice conditions in specialized centers from Argentina. Participants were also divided according to previous bisphosphonate treatment into BP-naïve and BP-prior. A control group of patients treated with BP not switched to Dmab matched by sex, age, and body mass index was used. Data are expressed as mean ± SEM. After 1 year of treatment with Dmab the bone formation markers total alkaline phosphatase and osteocalcin were significantly decreased (23.36% and 43.97%, resp.), as was the bone resorption marker s-CTX (69.61%). Significant increases in BMD were observed at the lumbar spine, femoral neck, and total hip without differences between BP-naïve and BP-prior. A better BMD response was found in BP-prior group compared with BP treated patients not switched to Dmab.Conclusion. Dmab treatment increased BMD and decreased bone turnover markers in the whole group, with similar response in BP-naïve and BP-prior patients. A better BMD response in BP-prior patients versus BP treated patients not switched to Dmab was observed.


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