Two-year Longitudinal Changes in Forearm Cortical Bone Geometry in Postmenopausal Women with Mild Primary Hyperparathyroidism without Parathyroidectomy

Abstract

Several studies suggest that mild PTH excess does not have any deteriorative effects on bone mineral density (BMD) in several-year-longitudinal studies of patients with mild primary hyperparathyroidism (pHPT) without parathyroidectomy (PTX). However, it remains unknown about the change in bone geometry in pHPT patients without PTX. We examined the longitudinal effects of mild PTH excess on cortical bone geometry in postmenopausal patients with mild pHPT without PTX by using peripheral quantitative computed tomography (pQCT), and we compared them with normal and hypoparathyroidism women. Nine postmenopausal female patients who were diagnosed as pHPT, six postmenopausal female patients with hypoparathyroidism (3 idiopathic and 3 postoperative), and thirty postmenopausal control subjects participated in this study. Radial volumetric (v) BMD and several bone geometry parameters were measured by pQCT at basal line and after 2 years. Cortical vBMD was significantly lower in pHPT group. Moreover, total area and periosteal circumferences were significantly higher in pHPT group. Total and cortical vBMD were significantly decreased after 2 years in control group. However, they were stable in pHPT group after 2-year follow-up. As for bone geometry, cortical thickness and area were also stable in pHPT group during 2-year follow-up, although they were significantly reduced in control group and hypoparathyroidism group. In conclusion, the present longitudinal study revealed that there were no significant changes in radial vBMD and cortical bone geometry in postmenopausal women with mild pHPT, whereas age-related thinning of cortical bone as well as decrease of vBMD were observed in the control and patients with hypoparathyroidism.

primary hyperparathyroidism - bone geometry - bone mineral density - osteoporosis - hypoparathyroidism

References

• 1 Abugassa S, Nordenstrom J, Eriksson S. et al . Bone mineral density in patients with chronic hypoparathyroidism.  J Clin Endocrinol Metab. 1993;  76 1617-1621
• 2 Ahlborg HG, Johnell O, Turner CH. et al . Bone loss and bone size after menopause.  N Engl J Med. 2003;  349 327-334
• 3 Andersson N, Lindberg MK, Ohlsson C. et al . Repeated in vivo determinations of bone mineral density during parathyroid hormone treatment in ovariectomized mice.  J Endocrinol. 2001;  170 529-537
• 4 Bilezikian JP. Bone strength in primary hyperparathyroidism.  Osteoporos Int. 2003;  14 ((Suppl. 5)) S113-S117
• 5 Charopoulos I, Tournis S, Trovas G. et al . Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomograpgy in postmenopausal women.  J Clin Endocrinol Metab. 2006;  91 1748-1753
• 6 Chen Q, Kaji H, Iu MF. et al . Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects.  J Clin Endocrinol Metab. 2003;  88 4655-4658
• 7 Dempster DW, Parisien M, Silverberg SJ. et al . On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism.  J Clin Endocrinol Metab. 1999;  84 1562-1566
• 8 Fujiyama K, Kiriyama T, Ito M. et al . Attenuation of postmenopausal high turnover bone loss in patients with hypoparathyroidism.  J Clin Endocrinol Metab. 1995;  80 2135-2138
• 9 Grey AB, Evans MC, Stapleton JP. et al . Body weight and bone mineral density in postmenopausal women with primary hyperparathyroidism.  Ann Intern Med. 1994;  121 745-749
• 10 Jimenz LE, Spinks TJ, Ranicar AS. et al . Total body calcium mass in primary hyperparathyroidism and long-term changes.  Calcif Tissue Int. 1984;  36 14-18
• 11 Kaji H, Yamauchi M, Nomura R. et al . Improved peripheral cortical bone geometry after surgical treatment of primary hyperparathyroidism in postmenopausal women.  J Clin Endocrinol Metab. 2008;  93 3045-3050
• 12 Lehmann R, Wapniarz M, Kvasnicka HM. et al . Reproducibility of bone density measurements of the distal radius using a high resolution special scanner for peripheral quantitative computed tomography (Single Energy PQCT).  Radiology. 1992;  32 177-181
• 13 Nakaoka D, Sugimoto T, Kobayashi T. et al . Prediction of bone mass change after parathyroidectomy in patients with primary hyperparathyroidism.  J Clin Endocrinol Metab. 2000;  85 1901-1907
• 14 Nomura R, Sugimoto T, Tsukamoto T. et al . Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; a six-year longitudinal study with or without parathyroidectomy in a Japanese population.  Clin Endocrinol. 2004;  60 335-342
• 15 Oleksik A, Ott SM, Vedi S. et al . Bone structure in patients with low bone mineral density with or without vertebral fractures.  J Bone Miner Res. 2000;  15 1368-1375
• 16 Parfitt AM, Rao DS, Kleerekoper M. Asymptomatic primary hyperparathyroidism discovered by multichannnel biochemical screening: clinical course and considerations bearing on the need for surgical intervention.  J Bone Miner Res. 1991;  6 ((Suppl. 2)) S97-S101
• 17 Parisien M, Silverberg SJ, Shane E. et al . The histomorphometry of bone in primary hyperparathyroidismm; preservation of cancellous bone.  J Clin Endocrinol Metab. 1990;  70 930-938
• 18 Parisien M, Mellish RW, Silverberg SJ. et al . Maintenance of cancellous bone connectivity in primary hyperparathyroidism; trabecular strut analysis.  J Bone Miner Res. 1992;  7 913-920
• 19 Parisien M, Cosman F, Mellish RW. et al . Bone structure in postmenopausal hyperparathyroid, osteoporotic, and normal women.  J Bone Miner Res. 1995;  10 1393-1399
• 20 Rao DS, Wilson RJ, Kleerekoper M. et al . Lack of biochemical progression or continouation of accrelated bone loss in mild asymptomatic primary hyperparathyroidism: evidence for biphasic disease course.  J Clin Endocrinol Metab. 1988;  67 1294-1298
• 21 Ruegsegger P, Durand E, Dambacher MA. Localization of regional forearm bone loss from high-resolution computed tomographic images.  Osteoporos Int. 1991;  1 76-80
• 22 Russo CR, Lauretani F, Bandinelli S. et al . Aging bone in men and women: beyond changes in bone mineral density.  Osteoporos Int. 2003;  14 531-538
• 23 Schiessl H, Ferretti JL, Tysarczyk-Niemeyer G. Noninvasive bone strength index as analysis by peripheral quantitative computed tomography (pQCT). In: Schonau E, ed. Pediatric Osteology. New Developments in Diagnostics and Therapy. Elsevier, Amsterdam 1996: 147-160
• 24 Seeman E. From density to structure: growing up and growing old on the surfaces of bone.  J Bone Miner Res. 1997;  12 509-521
• 25 Silverberg SJ, Shane E, La Cruz L De. et al . Skeletal disease in primary hyperparathyroidism.  J Bone Miner Res. 1989;  4 283-291
• 26 Silverberg SJ, Gartenberg F, Jacobs TP. et al . Longitudinal measurements of bone density and biochemical indices in untreated primary hyperparathyroidism.  J Clin Endocrinol Metab. 1995a;  80 723-728
• 27 Silverberg SJ, Gartenberg F, Jacobs TP. et al . Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism.  J Clin Endocrinol Metab. 1995b;  80 729-734
• 28 Silverberg SJ, Loker FG, Bilezikian JP. Vertebral osteopenia: a new indication for surgery in primary hyperparathyroidism.  J Clin Endocrinol Metab. 1996;  81 4007-4012
• 29 Silverberg SJ, Shane E, Jacobs TP. et al . A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery.  N Engl J Med. 1999;  341 1249-1255
• 30 Zanchetta J, Bogado C, Ferretti J. et al . Effects of teriparatide [recombinant human parathyroid hormone (1–34)] on cortical bone in postmenopausal women with osteoporosis.  J Bone Miner Res. 2003;  18 539-543

Correspondence