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[Bone mineral density in primary hyperparathyroidism].

J Kosowicz1, D Baszko-Błaszyk, W Horst-Sikorska

  • 1Klinika Endokrynologii AM w Poznaniu.

Polskie Archiwum Medycyny Wewnetrznej
|March 21, 2000
PubMed
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Primary hyperparathyroidism significantly reduces bone mineral density, particularly in cortical bone of the radius. Parathyroid adenomectomy effectively restores bone density, especially in trabecular bone of the lumbar spine.

Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Radiology

Background:

  • Primary hyperparathyroidism (PHPT) is associated with significant skeletal complications, including bone pain, weakness, deformities, and fractures.
  • Radiographic findings in advanced PHPT include subperiosteal bone resorption and cortical atrophy, but early changes may be subtle.
  • Dual-energy X-ray absorptiometry (DEXA) is a valuable tool for detecting early bone mineral density (BMD) changes in PHPT.

Purpose of the Study:

  • To evaluate BMD using DEXA in patients with primary hyperparathyroidism at sites rich in trabecular (lumbar spine) and cortical (distal radius) bone.
  • To assess the impact of parathyroid adenomectomy on BMD at these distinct skeletal sites.

Main Methods:

  • Twenty-three patients with confirmed primary hyperparathyroidism underwent DEXA scans of the lumbar spine and distal radius.

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  • Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels were measured.
  • Isotope scintigraphy (99mTc-MIBI) identified parathyroid adenomas, which were surgically removed and histopathologically confirmed.
  • Follow-up DEXA scans were performed 6-24 months post-surgery in 10 patients.

    • Main Results:

    • Patients with PHPT exhibited significantly reduced BMD in the distal radius (66.8% of age-matched range) compared to the lumbar spine (91.7% of age-matched range).
    • Post-parathyroid adenomectomy, lumbar spine BMD increased by 10-22% within the first year, while distal radius BMD showed a smaller increase of 6.3% per year.
    • A characteristic finding in PHPT was a >20% difference in BMD between cortical and trabecular bone, not observed in other osteoporosis types.

    Conclusions:

    • DEXA reveals pronounced BMD loss in the distal radius (cortical bone) and less severe loss in the lumbar spine (trabecular bone) in primary hyperparathyroidism.
    • Parathyroid adenomectomy rapidly improves trabecular bone density in the lumbar spine, with a slower recovery in cortical bone of the radius.
    • Significant differences in BMD between cortical and trabecular bone are a hallmark of hyperparathyroidism, distinguishing it from other forms of osteoporosis.