title: Long-term effects of neridronate and its discontinuation in patients with primary hyperparathyroidism.
abstract: In patients with primary hyperparathyroidism (PHPT) not suitable for surgical correction, a skeletal protection with bisphosphonates is considered a reasonable option, but the long-term effects after treatment discontinuation are not well known. Sixty postmenopausal women with PHPT were given 400-600 IU vitamin D(3) daily and 100 mg neridronate IV every 2 months for 2 years with 2 additional years of follow-up without antiresorptive therapies. Bone mineral density (BMD) progressively rose by 6.7 ± 7.6% (SD) and by 2.9 ± 4.5% at the spine and femoral neck, respectively. During follow-up, mean BMD progressively fell, but after 2 years it was still 3.9 ± 5.5% higher than baseline values at the spine. Bone alkaline phosphatase and serum C-telopeptide of type I collagen decreased significantly within 6 months (28 and 49% versus baseline, respectively) and rose to baseline values within 6-12 months during follow-up. Serum PTH significantly rose from baseline during treatment, but it remained significantly higher than baseline during follow-up. The PTH changes were significantly correlated with serum 25-hydroxyvitamin D (25OHD) levels. In conclusion, in this study we observed that in patients with mild PHPT treatment with bisphosphonates is associated with the expected changes in bone-turnover markers and that the significant increases of both hip and spine BMD are partially maintained for at least 2 years after treatment discontinuation at the vertebral site. The marked increases in serum PTH levels, particularly in subjects with low 25OHD levels, persist after treatment discontinuation and this raises the suspicion that this might reflect a worsening of PHPT.
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Verona, OCM Borgo Trento, P.le Stefani 1, 37126, Verona, Italy. maurizio.rossini@univr.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.forename: Banu
authors.initials: B
authors.lastname: Kalpakcioglu
authors.forename: Rajoo
authors.initials: R
authors.lastname: Dhangana
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
authors.forename: Vania
authors.initials: V
authors.lastname: Braga
authors.forename: Elena
authors.initials: E
authors.lastname: Fracassi
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002762:Cholecalciferol / Q000008:administration & dosage / Q000494:pharmacology; D024042:Collagen Type I / Q000378:metabolism; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005272:Femur Neck / Q000378:metabolism; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy* / Q000378:metabolism; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000097:blood; D010455:Peptides / Q000378:metabolism; D013995:Time
chemical_list: D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D010281:Parathyroid Hormone; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D002762:Cholecalciferol; C053389:6-amino-1-hydroxyhexane-1,1-diphosphonate; D000469:Alkaline Phosphatase