title: Bone metabolism in patients with primary hyperparathyroidism before and after surgery.
abstract: Primary hyperparathyroidism (PHPT) is accompanied with a reduced bone mineral density (BMD) and an increased risk of fracture. Surgery is the only option for cure. It is hypothesized that in patients with PHPT bone metabolism normalizes after parathyroidectomy (PTX) and that BMD gradually increases. Fifty-two patients with PHPT who underwent surgery were prospectively followed for 1 year. Biochemical analyses were performed at baseline and 1, 4, 7 days; 6 weeks; and 3, 6, and 12 months, and BMD before and one year after surgery. Parathyroid hormone (PTH), calcium, and the bone resorption marker dropped immediately, but transiently after PTX, bone formation decreased more slowly. Osteoprotegerin (OPG) as well as cathepsin K did not show significant changes. BMD of the lumbar spine, but not of the femoral neck, increased significantly within one year after surgery. Moderate correlations existed between the changes of total calcium, ionized calcium, as well as bone-specific alkaline phosphatase and changes of the lumbar BMD. Patients who needed postoperative supplementation with calcium and vitamin D had significantly higher PTH levels. Some gender-specific differences in patients with PHPT were observed. In patients with PHPT, males appear to be more severely affected than females. Within the first year after PTX, bone metabolism normalized, and BMD of the lumbar spine increased. Patients who needed a supplementation with calcium and vitamin D after PTX preoperatively had higher serum levels of PTH.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria. Katharina.Kerschan-Schindl@meduniwien.ac.at
authors.forename: K
authors.initials: K
authors.lastname: Kerschan-Schindl
authors.forename: P
authors.initials: P
authors.lastname: Riss
authors.forename: C
authors.initials: C
authors.lastname: Krestan
authors.forename: M
authors.initials: M
authors.lastname: Rauner
authors.forename: C
authors.initials: C
authors.lastname: Bieglmayer
authors.forename: A
authors.initials: A
authors.lastname: Gleiss
authors.forename: V
authors.initials: V
authors.lastname: Fialka-Moser
authors.forename: B
authors.initials: B
authors.lastname: Niederle
authors.forename: P
authors.initials: P
authors.lastname: Pietschmann
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism* / Q000503:physiopathology; D002118:Calcium / Q000097:blood; D024042:Collagen Type I / Q000097:blood; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010455:Peptides / Q000097:blood; D010710:Phosphates / Q000097:blood; D011184:Postoperative Period; D057234:Preoperative Period; D018709:Statistics, Nonparametric; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D024042:Collagen Type I; D010281:Parathyroid Hormone; D010455:Peptides; D010710:Phosphates; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002118:Calcium