title: Bisphosphonates can reduce bone hunger after parathyroidectomy in patients with primary hyperparathyroidism and osteitis fibrosa cystica.
abstract: OBJECTIVE
  To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica.
  
  
  METHODS
  Review of the medical records of six patients using bisphosphonates preoperatively.
  
  
  RESULTS
  Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm(2) (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm(2) (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm(2) (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33.
  
  
  CONCLUSIONS
  The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.
authors.affiliation: Centro de Osteoporose de Pernambuco, Department of Endocrinology, Hospital Agamenon Magalhães/SUS, Universidade de Pernambuco, Recife, PE, Brazil.
authors.forename: Tatiana Clementino Pinto Toscano de
authors.initials: TC
authors.lastname: França
authors.forename: Luiz
authors.initials: L
authors.lastname: Griz
authors.forename: Jorge
authors.initials: J
authors.lastname: Pinho
authors.forename: Erik Trovão
authors.initials: ET
authors.lastname: Diniz
authors.forename: Luena Dias de
authors.initials: LD
authors.lastname: Andrade
authors.forename: Cynthia Salgado
authors.initials: CS
authors.lastname: Lucena
authors.forename: Susyane Ribeiro
authors.initials: SR
authors.lastname: Beserra
authors.forename: Nadja Maria Jorge
authors.initials: NM
authors.lastname: Asano
authors.forename: Angela Pinto
authors.initials: AP
authors.lastname: Duarte
authors.forename: Francisco
authors.initials: F
authors.lastname: Bandeira
mesh_terms: D000328:Adult; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects*
chemical_list: D004164:Diphosphonates