[Alendronate increases bone mineral density in patients with symptomatic primary hyperparathyroidism]

Area of Science:

• Endocrinology
• Bone Metabolism
• Pharmacology

Background:

• Primary hyperparathyroidism (PHPT) frequently leads to reduced bone mineral density (BMD).
• Surgical parathyroidectomy is the standard treatment for symptomatic PHPT, but some patients refuse or are contraindicated for surgery.

Purpose of the Study:

• To evaluate the efficacy of alendronate (ALN) in maintaining or improving BMD in patients with symptomatic PHPT who declined surgery.
• To assess the impact of ALN on biochemical markers in PHPT patients.

Main Methods:

• An open-label, prospective trial involving 19 patients with symptomatic PHPT who refused surgery.
• Patients received alendronate (ALN) 10 mg daily for 2 years.
• Bone mineral density (BMD) was measured at the lumbar spine (LS) and femoral neck (FN) using dual-energy x-ray absorptiometry every 6 months. Serum calcium, phosphorus, PTH, and urinary calcium excretion were monitored every 3 months.

Main Results:

• Alendronate treatment resulted in a significant increase in LS BMD (5.3+/-0.4%) and FN BMD (2.5%+/-0.7%) at 24 months compared to baseline (p<0.01).
• Serum calcium, phosphorus, PTH, and urinary calcium excretion remained stable throughout the 2-year treatment period.
• No significant changes in biochemical markers were observed, indicating alendronate's targeted effect on BMD.

Conclusions:

• Alendronate significantly increases lumbar spine and femoral neck BMD in patients with symptomatic PHPT over 24 months.
• Alendronate is a viable alternative to parathyroidectomy for symptomatic PHPT patients with low BMD who are surgical candidates but decline or cannot undergo surgery.
• Alendronate therapy demonstrates efficacy in improving bone density without adversely affecting calcium and PTH levels in PHPT patients.