Effects of parathyroidectomy on bone remodeling markers and vitamin D status in patients with chronic kidney disease-mineral and bone disorder.
OBJECTIVE
Chronic renal failure (CRF) is often associated with bone disorders including chronic kidney disease-mineral and bone disorder (CKD-MBD). Parathyroid hormone (PTH) has a relationship to bone remodeling, and so this study was undertaken to evaluate changes in bone remodeling markers after parathyroidectomy (PTX).


METHODS
Twelve adult patients, mean age 43.4 +/- 12.7 years, of both genders, were evaluated, prior to and six months after PTX. Analysis of biochemical markers of bone metabolism, such as total and ionized calcium, phosphorus, 25(OH)D(3), total alkaline phosphatase (TAP), bone-specific alkaline phosphatase (BAP), intact PTH, osteoprotegerin (OPG), and tartrate-resistant acid phosphatase isoform 5b (TRAP), were measured.


RESULTS
No changes were observed after PTX in the serum total and ionized calcium, TAP, BAP, and 25(OH)D(3). After surgery there was a significant decrease in serum phosphorus, iPTH, and TRAP (P < 0.001). No significant change was observed in OPG; however there was a positive correlation between OPG and 25(OH)D(3) before and after surgery (r = 0.774, P = 0.014; and r = 0.706, P = 0.01, respectively). The percentage of patients with vitamin D deficiency decreased from 16.7% to 8.3%, while those with sufficient levels increased from 41.7% to 58.3%.


CONCLUSIONS
The small number of patients in the study notwithstanding, the present study is unique because it provides information on bone metabolism and vitamin D status six months after PTX. The removal of parathyroid glands significantly decreased bone resorption and indicated a tendency of 25(OH)D(3) concentration to increase. However, the precise role of OPG and BAP in the improvement in bone remodeling in patients with CKD-MBD requires further study.
Department of Nutrition, School of Health Public, University of Sao Paulo, Av. Dr. Arnaldo, 715, Sao Paulo, 01246-904, Brazil. bpeters@usp.br
Barbara Santarosa Emo
BS
Peters
Rosa Maria Affonso
RM
Moyses
Vanda
V
Jorgetti
Lígia Araújo
LA
Martini
D000328:Adult; D016723:Bone Remodeling; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology* / Q000601:surgery*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D049449:Luminescence; D008297:Male; D016105:Parathyroidectomy; D006435:Renal Dialysis; D018709:Statistics, Nonparametric; D014807:Vitamin D / Q000097:blood*
D014807:Vitamin D