Bone mineral density improvement after successful parathyroidectomy in pre- and postmenopausal women with primary hyperparathyroidism. A prospective study.

The aim of this study was to evaluate the short-term (1 year) changes of the lumbar spine (L2–L4) bone mineral density (LS-BMD) after parathyroidectomy (PTx) in pre- and postmenopausal women with primary hyperparathyroidism (PHPT). A series of 48 women (median age 56 years, range 23–82 years) with confirmed PHPT were prospectively enrolled in the study.Patientswho received both oral contraceptives less than 2 years before the diagnosis and estrogen replacement therapy have previously been excluded. All patients underwent LS-BMD by dual energy x-ray absorptiometry before surgery. Patients were divided into two groups: group A (n = 12) premenopausal, and group B (n = 36) postmenopausal patients. The LS-BMD was repeated 12 months after successful PTx. Basal LS-BMD (0.852 ± 0.061 vs. 0.748 ± 0.142 g/cm2), serum calcium (2.95 ± 0.23 vs. 2.94 ± 0.26 mmol/L), creatinine (69.2 ± 17.5 vs. 82.0 ± 24.2 mol/L), alkaline phosphatase (107.4 ± 43.6 vs. 151.3±95.7 U/L), osteocalcin (28.6±9.3 vs. 28.2±8.3 g/L), and PTH (192.7 ± 133.2 vs. 175.2 ± 132.1 ng/L) levels did not differ significantly (P = NS) between groups. The 1-year LS-BMD was 0.921 ± 0.048 and 0.825 ± 0.151 g/cm2 in group A and B, respectively. In group B patients, the 1-yearLS-BMDvalue did not improve significantly (P=NS),while in group A patients the difference between basal and postsurgical LS-BMD was significant (P < 0.01). In conclusion, PTx should be considered for all patients with PHPT and loss of bone density, but in premenopausal patients a greatest improvement of BMD may be found, suggesting the need of endogenous estrogens in complete lumbar bone recovery after surgery.