PDF herunterladen
Horm Metab Res 2012; 44(06): 476-481
DOI: 10.1055/s-0032-1308998
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Bone Metabolism in Patients with Primary Hyperparathyroidism Before and After Surgery

K. Kerschan-Schindl
1    Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
,
P. Riss
2    Section “Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
C. Krestan
3    Department of Radiology, Medical University of Vienna, Vienna, Austria
,
M. Rauner
4    Ludwig Bolzmann Institute of Ageing Research, Vienna, Austria
5    Division of Endocrinology, Diabetes, and Metabolic Bone Diseases, Department of Medicine III, Technical University, Dresden, Germany
,
C. Bieglmayer
6    Department of Biochemistry, Medical University of Vienna, Vienna, Austria
,
A. Gleiss
7    Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
,
V. Fialka-Moser
1    Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
,
B. Niederle
2    Section “Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
P. Pietschmann
8    Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 29. November 2011

accepted 07. März 2012

Publikationsdatum:
11. April 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Primary hyperparathyroidism (PHPT) is accompanied with a reduced bone mineral density (BMD) and an increased risk of fracture. Surgery is the only option for cure. It is hypothesized that in patients with PHPT bone metabolism normalizes after parathyroidectomy (PTX) and that BMD gradually increases. Fifty-two patients with PHPT who underwent surgery were prospectively followed for 1 year. Biochemical analyses were performed at baseline and 1, 4, 7 days; 6 weeks; and 3, 6, and 12 months, and BMD before and one year after surgery. Parathyroid hormone (PTH), calcium, and the bone resorption marker dropped immediately, but transiently after PTX, bone formation decreased more slowly. Osteoprotegerin (OPG) as well as cathepsin K did not show significant changes. BMD of the lumbar spine, but not of the femoral neck, increased significantly within one year after surgery. Moderate correlations existed between the changes of total calcium, ionized calcium, as well as bone-specific alkaline phosphatase and changes of the lumbar BMD. Patients who needed postoperative supplementation with calcium and vitamin D had significantly higher PTH levels. Some gender-specific differences in patients with PHPT were observed. In patients with PHPT, males appear to be more severely affected than females. Within the first year after PTX, bone metabolism normalized, and BMD of the lumbar spine increased. Patients who needed a supplementation with calcium and vitamin D after PTX preoperatively had higher serum levels of PTH.

Key words

primary hyperparathyroidism - surgery - bone metabolism - gender - OPG - cathepsin K
 

  • References

  • 1 Eriksen EF, Mosekilde L, Melsen F. Trabecular bone remodeling and balance in primary hyperparathyroidism. Bone 1986; 7: 213-221
    CrossrefPubMedGoogle Scholar
  • 2 Pietschmann P, Niederle B, Anvari A, Woloszczuk W. Serum osteocalcin levels in primary hyperparathyroidism. Klin Wochenschr 1991; 69: 351-353
    CrossrefPubMedGoogle Scholar
  • 3 Christiansen P, Steiniche T, Vesterby A, Mosekilde L, Hessov I, Melsen F. Primary hyperparathyroidism: iliac crest trabecular bone volume, structure, remodeling, and balance evaluated by histomorphometric methods. Bone 1992; 13: 41-49
    CrossrefPubMedGoogle Scholar
  • 4 Chen Q, Kaji H, Iu MF, Nomura R, Sowa H, Yamauchi M, Tsukamoto T, Sugimoto T, Chihara K. 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
    CrossrefPubMedGoogle Scholar
  • 5 Khosla S, Melton III LJ, Wermers RA, Crpwsn CS, O’Fallong WM, Riggs BL. Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res 1999; 14: 1700-1707
    CrossrefPubMedGoogle Scholar
  • 6 Gittoes NJL, Cooper MS. Primary hyperparathyroidism – is mild disease worth treating?. Clin Med 2010; 10: 45-49
    PubMedGoogle Scholar
  • 7 Rauner M, Sipos W, Pietschmann P. Osteoimmunology. Int Arch Allergy Immunol 2007; 143: 31-48
    CrossrefPubMedGoogle Scholar
  • 8 Fraher U, Watson PH, Kisiel M, Natale BV, Hodsman AB. Measurement of circulating osteoprotegerin (OPG) in human sera: inhibition of circulating OPG in osteoporotic patients treated with hPTH (1-34). ASBMR; Toronto: 2000. (abstract)
    Google Scholar
  • 9 Nakchbandi IA, Lang R, Kinder B, Insogna KL. The role of the receptor activator of nuclear factor-kB ligand/osteoprotegerin cytokine system in primary hyperparathyroidism. J Clin Endocrinol Metab 2008; 93: 967-973
    CrossrefPubMedGoogle Scholar
  • 10 Stilgren LS, Hegedüs LM, Beck-Nielsen H, Abrahamsen B. Osteoprotegerin levels in primary hyperparathyroidism: effect of parathyroidectomy and association with bone metabolism. Calcif Tissue Int 2003; 73: 210-216
    CrossrefPubMedGoogle Scholar
  • 11 Stilgren LS, Rettmer E, Hegedüs LM, Beck-Nielsen H, Abrahamsen B. Skeletal changes in osteoprotegerin and receptor activator of nuclear factor-κB ligand mRNA levels in primary hyperparathyroidism: effect of parathyroidectomy and association with bone metabolism. Bone 2004; 35: 256-265
    CrossrefPubMedGoogle Scholar
  • 12 Hesch RD. Die konservative Therapie des extrarenalen Hyperparathyroidismus. In: Beyer J, Krause U. (eds.). Therapie des Hyperparathyroidismus. Stuttart: Schattauer; 1981: 51-69
    Google Scholar
  • 13 Prager G, Czerny C, Kurtaran A, Passler C, Scheuba C, Bieglmayer C, Niederle B. Minimally invasive open parathyroidectomy in an endemic goiter area: a prospective study. Arch Surg 2001; 36: 810-816
    PubMedGoogle Scholar
  • 14 Riss P, Kaczirek K, Heinz G, Bieglmayer C, Niederle B. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease. Surgery 2007; 142: 398-404
    CrossrefPubMedGoogle Scholar
  • 15 Tanaka Y, Naruse T, Funahashi H, Imai T, Suzumura K, Mase T, Tominaga Y. Bone metabolic analysis in patients with primary hyperparathyroidism. Biomed Pharmacother 2000; 54 (Suppl. 01) 97s-99s
    CrossrefPubMedGoogle Scholar
  • 16 Garton M, Martin J, Stewart A, Krukowski Z, Matheson N, Robins S, Loveridge N, Reid D. Changes in bone mass and metabolism after surgery for primary hyperparathyroidism. Clin Endocrinol 1995; 42: 493-500
    CrossrefPubMedGoogle Scholar
  • 17 Davies C, Demeure St MJ, John A, Edis AJ. Study of intact (1-84) parathyroid hormone secretion in patients undergoing parathyroidectomy. World J Surg 1990; 14: 355-360
    CrossrefPubMedGoogle Scholar
  • 18 Carty SE, Roberts MM, Virji MA, Haywood L, Yim JH. Elevated serum parathormone level after “concise parathyroidectomy” for primary sporadic hyperparathyroidism. Surgery 2002; 132: 1086-1093
    CrossrefPubMedGoogle Scholar
  • 19 Biskobing DM. Significance of elevated parathyroid hormone after parathyroidectomy. Endocrine Practice 2010; 16: 112-117
    CrossrefPubMedGoogle Scholar
  • 20 Nordenstöm E, Westerdahl J, Bergenfelz A. Long-term follow-up of patients with elevated PTH levels following successful exploration for primary hyperparathyroidism. World J Surg 2004; 28: 570-575
    PubMedGoogle Scholar
  • 21 Guo CY, Holland PA, Jackson BF, Hannon RA, Rogers A, Harrison BJ, Eastell R. Immediate changes in biochemical markers of bone turnover and circulating interleukin-6 after parathyroidectomy for primary hyperparathyroidism. Eur J Endocrinol 2000; 142: 451-459
    CrossrefPubMedGoogle Scholar
  • 22 Lumachi F, Ermani M, Basso SM, Camozzi V, Nardi A, Favia G, Luisetto G. Short- and long-term changes in bone mineral density of the lumbar spine after parathyroidectomy in patients with primary hyperthyroidism. Calcif Tissue Int 2003; 73: 44-48
    CrossrefPubMedGoogle Scholar
  • 23 Ominsky MS, Stolina M, Li X, Corbin TJ, Asuncion FJ, Barrero M, Niu QT, Dwyer D, Adamu S, Warmington KS, Grisanti M, Tan HL, Ke HZ, Simonet WS, Kostenuik PJ. One year of transgenic overexpression of osteoprotegerin in rats suppressed bone resorption and increased vertebral bone volume, density and strength. J Bone Miner Res 2009; 24: 1234-1246
    CrossrefPubMedGoogle Scholar
  • 24 Drake MT, Srinivasan B, Mödder UI, Peterson JM, McCready LK, Riggs BL, Dwyer D, Stolina M, Kostenuik P, Khosla S. Effects of parathyroid hormone treatment on circulating sclerostin levels in postmenopausal women. J Clin Endorcinol Metabol 2010; 95: 5056-5062
    PubMedGoogle Scholar
  • 25 Muñoz-Torres M, Reyes-García R, Mezquita-Raya P, Fernández-García D, Alonso G, Luna Jde D, Ruiz-Requena ME, Escobar-Jiménez F. Serum cathepsin K as a marker of bone metabolism in postmenopausal women treated with alendronate. Maturitas 2009; 64: 188-192
    CrossrefPubMedGoogle Scholar
  • 26 Christiansen P, Steiniche T, Brixen K, Hessov I, Melsen F, Heickendorff L, Mosekilde L. Primary hyperparathyroidism: short-term changes in bone remodeling and bone mineral density following parathyroidectomy. Bone 1999; 25: 237-244
    CrossrefPubMedGoogle Scholar
  • 27 Hagström E, Lundgren E, Mallmin H, Rastad J, Hellman P. Positive effect of parathyroidectomy on bone mineral density in mild asymptomatic primary hyperparathyroidism. J Int Med 2006; 259: 191-198
    CrossrefPubMedGoogle Scholar
  • 28 Sitges-Serra A, Prieto R, Pena MJ, Nogues X, Sancho JJ. Effect of parathyroidectomy for primary hyperparathyroidism on bone mineral density in postmenopausal women. Br J Surg 2010; 97: 1013-1019
    CrossrefPubMedGoogle Scholar
  • 29 Lumachi F, Camozzi V, Ermani M, Naradi A, Luisetto G. Lumbar spine bone mineral density changes in patients with primary hyperparathyroidism according to age and gender. Ann NY Acad Sci 2007; 1117: 362-366
    CrossrefPubMedGoogle Scholar
  • 30 Eriksen EF. Primary hyperparathyroidism: lessons from bone histomorphometry. JBMR 2002; 17: N95-N97
    PubMedGoogle Scholar
  • 31 Siilin H, Lundgren E, Mallmin H, Mellström D, Ohlsson C, Karlsson M, Orwoll E, Ljunggren O. Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World J Surg 2011; 35: 1266-1272
    PubMedGoogle Scholar