title: BMD improvements after operation for primary hyperparathyroidism.
abstract: OBJECTIVE
  This study aims to quantify bone mineral density (BMD) changes following surgery in patients with primary hyperparathyroidism (PHPT) and to assess their relationship with clinical and biochemical variables.
  
  
  METHODS
  A historic cohort of 236 PHPT patients with DXA scans pre- and 1-year postoperatively, clinical data, and biochemical data was analyzed.
  
  
  RESULTS
  The mean age was 60 years (range 19-86) and 81 % of the patients were women. A significant postoperative 2.6 % (95 % CI, 2.1; 3.1) increase in lumbar spine BMD was seen. The increase in BMD was positively associated with preoperative plasma PTH (p = 0.002), Ca(2+) (p < 0.001), and alkaline phosphatase (p = 0.014). Hip BMD increased 1.5 % (1.1; 1.9). The increase in BMD was positively associated with preoperative plasma PTH (p = 0.005) and Ca(2+) (p < 0.001) and inversely associated with plasma creatinine (p = 0.004) and age (p = 0.018). Total forearm BMD did not change significantly (-0.2 % (-0.5; 0.1)). An increase in forearm BMD was seen in 38 % of all patients, and the changes were positively associated with plasma PTH (p < 0.001) and Ca(2+) (p = 0.009). In all 91 patients with mild PHPT (plasma Ca(2+) < 1.45 mmol/l), there was a significant postoperative increase in spine BMD (1.9 % (1.2; 2.7)) and in hip BMD (1.0 % (0.4; 1.6)), but not in the forearm BMD (-0.3 % (-0.7; 0.2)). The postoperative BMD gain was higher in the hip and forearm in patients operated for adenomas compared with patients treated for hyperplasia.
  
  
  CONCLUSIONS
  We found significant postoperative BMD improvements both at the hip and the spine. BMD improvements were also significant in mild cases. At all scan sites, there were positive associations between preoperative plasma PTH levels and postoperative BMD increases. The measured BMD changes may mainly be due to a decrease in PTH-induced bone turnover with refilling of the remodeling space.
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark. larsrolighed@gmail.com
authors.forename: Lars
authors.initials: L
authors.lastname: Rolighed
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.forename: Lene
authors.initials: L
authors.lastname: Heickendorff
authors.forename: Tanja
authors.initials: T
authors.lastname: Sikjaer
authors.forename: Lars
authors.initials: L
authors.lastname: Rejnmark
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
authors.forename: Peer
authors.initials: P
authors.lastname: Christiansen
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003718:Denmark; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D003404:Creatinine; D002118:Calcium