Bone mineral density analysis in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1 after total parathyroidectomy.
OBJECTIVE
Limited data have been reported on the effect of parathyroidectomy (PTx) on bone mineral density (BMD) in the setting of patients with hyperparathyroidism (HPT) associated with multiple endocrine neoplasia type 1 (MEN1). This study investigates the impact of total PTx on BMD in patients with HPT/MEN1.


METHODS
A case series study was performed in a tertiary academic hospital. A total of 16 HPT/MEN1 patients from six families harbouring MEN1 germline mutations were subjected to total PTx followed by parathyroid auto-implant in the forearm.


METHODS
Bone mineral density values were assessed using dual-energy X-ray absorptiometry.


RESULTS
Before PTx, reduced BMD (Z-score <-2.0) was highly prevalent in the proximal one-third of the distal radius (1/3 DR) (50%), lumbar spine (LS) (43.7%), ultradistal radius (UDR) (43.7%), femoral neck (FN) (25%) and total femur (TF) (18.7%) in the patients. Fifteen months after PTx, we observed a BMD improvement in the LS (from 0.843 to 0.909 g/cm(2); +8.4%, P = 0.001), FN (from 0.745 to 0.798 g/cm(2); +7.7%, P = 0.0001) and TF (from 0.818 to 0.874 g/cm(2); +6.9%, P < 0.0001). No significant change was noticed in the 1/3 DR and UDR after PTx.


CONCLUSIONS
This data confirmed BMD recovery in the LS and FN after PTx in HPT/MEN1 patients. We also documented a significant BMD increase in the TF and no change in both the 1/3 DR and UDR BMD after PTx. Our data suggest that LS and proximal femur are the most informative sites to evaluate the short-term BMD outcome after PTx in HPT/MEN1 subjects.
Coutinho
Flavia L
FL
Endocrine Genetics Unit (LIM-25), Division of Endocrinology, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo, Brazil.
Lourenço
Delmar M
DM
Toledo
Rodrigo A
RA
Montenegro
Fabio L M
FL
Correia-Deur
Joya E M
JE
Toledo
Sergio P A
SP
D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery*; D016105:Parathyroidectomy