title: Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism.
abstract: BACKGROUND
  Recent studies showed association between hyperaldosteronism and low bone density among patients with primary aldosteronism (PA) due to secondary hyperparathyroidism. Our objective is to assess bone turnover markers (BTM) and bone mineral density (BMD) of PA patients compared to essential hypertension.
  
  
  METHODS
  This was an open-label, prospective, case-controlled study, conducted over 12 months. Fifty-two consecutive patients referred for secondary hypertension were screened. Eighteen patients with confirmed PA (diagnosis based on the Endocrine Society clinical guideline) and seventeen matched controls with essential hypertension were recruited. BTM (CTX and P1NP), BMD, intact parathyroid hormone (iPTH), and bone profile were assessed at baseline and three months following treatment among the PA patients. Calcium intake was assessed using a validated questionnaire. Primary outcomes were the changes of bone markers and BMD following treatment of PA, and their relation to other parameters.
  
  
  RESULTS
  PA patients had significantly lower serum calcium and higher iPTH despite comparable vitamin D levels with control group. Both BTM were significantly higher among the PA group. BMD of lumbar spine, neck of femur and distal radius did not differ between groups. Three months following treatment, there were significant: 1) reduction in BTM; 2) improvement in the lumbar spine BMD; 3) reduction in iPTH level; and 4) increment of serum 25-OH vitamin D level.
  
  
  CONCLUSIONS
  Our findings support that bone loss and potential fracture risk among PA patients are likely a result of aldosterone-mediated secondary hyperparathyroidism. Patients with early PA may already exhibit increased bone turnover despite no significant changes in BMD.
authors.affiliation: Faculty of Medicine and Health Sciences, Malaysia Sarawak University, Sarawak, Malaysia.
authors.forename: Huai H
authors.initials: HH
authors.lastname: Loh
authors.affiliation: Endocrine Unit, Department of Medicine, National University of Malaysia Medical Center, Selangor, Malaysia.
authors.forename: Nor A
authors.initials: NA
authors.lastname: Kamaruddin
authors.affiliation: Department of Radiology, National University of Malaysia Medical Center, Selangor, Malaysia.
authors.forename: Rozman
authors.initials: R
authors.lastname: Zakaria
authors.affiliation: Endocrine Unit, Department of Medicine, National University of Malaysia Medical Center, Selangor, Malaysia - drlela2020@yahoo.com.
authors.forename: Norlela
authors.initials: N
authors.lastname: Sukor
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015519:Bone Density; D016723:Bone Remodeling; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers