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Bone disease in primary hyperparathyroidism.
Francisco Bandeira1, Natalie E Cusano2, Barbara C Silva3
1Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, Brazilian Ministry of Health.
Severe primary hyperparathyroidism (PHPT) causes osteitis fibrosa cystica (OFC), leading to bone pain and fractures. Bone mineral density loss in OFC is reversible with surgical treatment.
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Area of Science:
- Endocrinology
- Orthopedics
- Radiology
Background:
- Severe primary hyperparathyroidism (PHPT) classically presents with osteitis fibrosa cystica (OFC), a bone disease.
- OFC is characterized by bone pain, skeletal deformities, pathological fractures, and low bone mineral density.
Purpose of the Study:
- To describe the clinical and radiographic features of bone disease in severe PHPT.
- To highlight the reversibility of bone disease after surgical intervention.
- To introduce newer technologies for assessing skeletal involvement in PHPT.
Main Methods:
- Review of clinical manifestations including bone pain, fractures, muscle weakness, and neurological signs.
- Radiographic analysis detailing diffuse demineralization, fractures, and characteristic bone lesions like brown tumors and cysts.
- Mention of advanced imaging techniques such as Trabecular Bone Score (TBS) and high-resolution peripheral quantitative computed tomography (HR-pQCT).
Main Results:
- Bone disease in PHPT includes salt-and-pepper skull, phalangeal erosions, brown tumors, and diffuse demineralization on radiography.
- Pathological fractures commonly affect long bones.
- Marked elevation of serum calcium and PTH, along with renal complications like nephrolithiasis, are observed in severe cases.
Conclusions:
- Osteitis fibrosa cystica in severe PHPT leads to significant skeletal morbidity.
- Bone disease and low bone mineral density are reversible following surgical cure of PHPT.
- Emerging technologies like TBS and HR-pQCT offer enhanced insights into PHPT-related bone microarchitecture.