Introduction. The aim of this study was to analyze the femoral neck and lumbar spine BMD changes in patients with PHPT following successful PTx, and to correlate the results with the age and sex of the patients. Patients and Methods. Thirty-nine patients (median age 57 years, range 23-76) with confirmed PHPT underwent both femoral neck and lumbar (L2-L4 region) spine osteodensitometry using a dual-energy X-ray absorptiometry. Patients were divided into three groups: Group A (12 premenopausal women, mean age 44.1 +/- 9.0 years), Group B (16 postmenopausal women, mean age 64.2 +/- 6.9 years; p=0.00), and Group C (11 men, mean age 54.1 +/- 14.8 years; p=NS in respect of women’s age). None of the Group B patients had received estrogen replacement therapy at any time, and no Group A patient had used oral contraceptives. Preoperative s-alkaline phosphatase (ALP), s-bone-ALP, s-osteocalcin, and s-PTH 1-88 levels did not differ significantly (p=NS) among the three groups. In Group A patients s-creatinine levels were lower (p=0.016), whereas s-calcium levels (A=2.94 +/- 0.24, B=2.80 +/- 0.17, C=2.92 +/- 0.25 mmol/L; p=0.012), L2-L4 BMD values (A=0.8588 +/- 0.0781, B=0.7301 +/- 0.1363, C=0.8002 +/- 0.1465 g/cm2; p=0.007), and trochanteric BMD values (A=0.5871 +/- 0.0964, B=0.5213 +/- 0.2117, C=0.6865 +/- 0.9703 g/cm2; p=0.023) were higher. Results. At short-term (mean 13 months, range 9-15 months) follow-up following successful PTx all biochemical parameters were normal with significant (p<0.05) differences in respect of the preoperative values. Overall postoperative BMD values improved between 4.77% and 11.48% (median 6.37%). Significant differences were found only in Group A (L2-L4=0.8588 +/- 0.0781 vs 0.9575 +/- 0.1063, p=0.016; femoral neck=0.6056 +/- 0.1217 vs 0.722 +/- 0.1382, p=0.039; total hip: 0.7415 +/- 0.1424 vs 0.8890 +/- 0.1267, p=0-013) and in Group C patients (0.8002 +/- 0.1465 vs 0.9411 +/- 0.137, p=0.023). Conclusions: In patients with PHPT, at long-term follow-up, BMD of the lumbar spine significantly improves after PTx in premenopausal women, suggesting a higher bone sensitivity to serum PTH normalization.

Femoral and lumbar spine BMD changes in patients with primary hyperparathyroidism. Different improvement following successful parathyroidectomy in male and female patients

LUMACHI, FRANCO;LUISETTO, GIOVANNI;CAMOZZI, VALENTINA
2001

Abstract

Introduction. The aim of this study was to analyze the femoral neck and lumbar spine BMD changes in patients with PHPT following successful PTx, and to correlate the results with the age and sex of the patients. Patients and Methods. Thirty-nine patients (median age 57 years, range 23-76) with confirmed PHPT underwent both femoral neck and lumbar (L2-L4 region) spine osteodensitometry using a dual-energy X-ray absorptiometry. Patients were divided into three groups: Group A (12 premenopausal women, mean age 44.1 +/- 9.0 years), Group B (16 postmenopausal women, mean age 64.2 +/- 6.9 years; p=0.00), and Group C (11 men, mean age 54.1 +/- 14.8 years; p=NS in respect of women’s age). None of the Group B patients had received estrogen replacement therapy at any time, and no Group A patient had used oral contraceptives. Preoperative s-alkaline phosphatase (ALP), s-bone-ALP, s-osteocalcin, and s-PTH 1-88 levels did not differ significantly (p=NS) among the three groups. In Group A patients s-creatinine levels were lower (p=0.016), whereas s-calcium levels (A=2.94 +/- 0.24, B=2.80 +/- 0.17, C=2.92 +/- 0.25 mmol/L; p=0.012), L2-L4 BMD values (A=0.8588 +/- 0.0781, B=0.7301 +/- 0.1363, C=0.8002 +/- 0.1465 g/cm2; p=0.007), and trochanteric BMD values (A=0.5871 +/- 0.0964, B=0.5213 +/- 0.2117, C=0.6865 +/- 0.9703 g/cm2; p=0.023) were higher. Results. At short-term (mean 13 months, range 9-15 months) follow-up following successful PTx all biochemical parameters were normal with significant (p<0.05) differences in respect of the preoperative values. Overall postoperative BMD values improved between 4.77% and 11.48% (median 6.37%). Significant differences were found only in Group A (L2-L4=0.8588 +/- 0.0781 vs 0.9575 +/- 0.1063, p=0.016; femoral neck=0.6056 +/- 0.1217 vs 0.722 +/- 0.1382, p=0.039; total hip: 0.7415 +/- 0.1424 vs 0.8890 +/- 0.1267, p=0-013) and in Group C patients (0.8002 +/- 0.1465 vs 0.9411 +/- 0.137, p=0.023). Conclusions: In patients with PHPT, at long-term follow-up, BMD of the lumbar spine significantly improves after PTx in premenopausal women, suggesting a higher bone sensitivity to serum PTH normalization.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11577/1350519
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