Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy.
BACKGROUND
After parathyroidectomy, recovery of osteitis fibrosa cystica, which continues to dominate presentation of primary hyperparathyroidism in India has not been documented objectively.


METHODS
We followed up clinical recovery, biochemic markers of bone turnover, bone mineral density, and skeletal radiology in 51 patients with primary hyperparathyroidism and osteitis fibrosa cystica for 9 to 124 months (median, 32 months).


RESULTS
After parathyroidectomy, 46 patients had hypocalcemia. During postoperative week 1, bone pain improved in 71%. During 3 months, appendicular fractures healed in all 33 such patients, and 6 of 7 patients who were bedridden could walk. Mean bone mineral density increments (percent change/y) seen at various sites at 1 week, 3, 6, and 12 months were distal forearm--37, 28, 23, 21; lumbar spine--165, 104, 101, 106; and total hip--168, 157, 166, 133. Follow-up radiographs demonstrated prompt recovery though disorderly remineralization. Brown tumors and fractures showed hyperdensities within 3 months. Brown tumors regressed partially in 6 of 27 patients after 6 months.


CONCLUSIONS
After parathyroidectomy, patients with primary hyperparathyroidism have early, marked, and sustained recovery of osteitis fibrosa cystica. Early (1 week) bone mineral density increments of > 100%/y hint at the skeleton's ability to promptly restore itself. Densitometric recovery is prompt at cancellous (lumbar spine), but not at cortical (forearm) bone sites. Contour defects and bony tumors persist, and may need corrective osteotomies.
Agarwal
Gaurav
G
Department of Endocrine Surgery, Endocrine Sciences Centre, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India.
Mishra
Saroj K
SK
Kar
Dilip K
DK
Singh
Anil K
AK
Arya
Vivek
V
Gupta
Sushil K
SK
Mithal
Ambrish
A
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D015519:Bone Density; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010758:Phosphorus / Q000097:blood; D011859:Radiography; D020127:Recovery of Function; D016896:Treatment Outcome
D015415:Biomarkers; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium