Long-term irreversibility of bone loss after surgery for primary hyperparathyroidism

We reported previously that radial bone mineral content was decreased in patients with primary hyperparathyroidism and remained subnormal 1 year after surgery. In this study, we reviewed the results of sequential measurements of the radial bone mineral content, performed up to 107 months after removal of the parathyroid adenoma in 71 patients suffering from primary hyperparathyroidism. Bone mineral content increased during the first year after surgery. During the period 1 to 8 months after removal of the adenoma, the mean monthly increment was 0.009 +/- 0.0022 g/cm for the radial epiphysis and 0.0084 +/- 0.0023 g/cm for the shaft. However, in 39 patients seen at the end of 1 year after surgery, the bone mineral content of the epiphysis remained more than 1 SD below the normal mean in 61% (24) of the patients and more than 2 SDs in 36% (14) of the patients. For the shaft, those percentages were 59% (23) and 26% (10), respectively. Thereafter, the monthly increment rate of bone mineral content decreased rapidly with time, so that only minor further increase could be expected. Data show that patients with a low bone mineral content when diagnosed with primary hyperparathyroidism will conserve life long an irreversible loss of bone as compared with a matched control population.