title: Bone mineral density and secondary hyperparathyroidism in pulmonary hypertension.
abstract: BACKGROUND
  Low bone mineral density (BMD) is common in chronic lung diseases and associated with reduced quality of life. Little is known about BMD in pulmonary hypertension (PH).
  
  
  METHODS
  Steroid-naïve patients with PH (n=34; 19 idiopathic, 15 chronic thromboembolic) had BMD measured by DXA at the time of diagnostic right heart catheterization. Exercise capacity, quality of life and various parameters related to PH severity and bone metabolism were also assessed. 24 patients with left heart failure (LHF) were similarly assessed as controls.
  
  
  RESULTS
  The prevalence of osteopenia was high both in PH (80%) and in controls with LHF (75%). Low BMD was associated with lean body mass, age, lower BMI, impaired exercise capacity and in PH with higher pulmonary vascular resistance. Serum parathyroid hormone (PTH) was elevated and considerably higher in PH than in LHF (above normal, in 55 vs 29%). Secondary hyperparathyroidism was not related to impaired renal function but possibly to low vitamin D status.
  
  
  CONCLUSIONS
  Osteopenia is common in PH and in chronically ill patients with LHF. Osteopenia is associated with known risk factors but in PH also with disease severity. Preventive measures in an increasingly chronic ill PH population should be considered. Secondary hyperparathyroidism is highly prevalent in PH and might contribute to bone and possibly pulmonary vascular disease. Whether adequate vitamin D substitution could prevent low BMD in PH remains to be determined.
authors.affiliation: Department of Internal Medicine, University Hospital of Zurich, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ulrich
authors.forename: Martin
authors.initials: M
authors.lastname: Hersberger
authors.forename: Manuel
authors.initials: M
authors.lastname: Fischler
authors.forename: Lars C
authors.initials: LC
authors.lastname: Huber
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.forename: Ursula
authors.initials: U
authors.lastname: Treder
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid