Bisphosphonate Therapy in Primary Hyperparathyroidism

Abstract

The summary statement from the Workshop on Asymptomatic Primary Hyperparathyroidism did not recommend bisphosphonate therapy because of "limited data."(1) We would suggest that there are bone mineral density (BMD) data supporting such a role from four trials, including two randomized trials, comprising a total of 119 postmenopausal women and 24 older men (Table 1). In the two randomized studies in 66 women, BMD increased in lumbar spine by 3.7-5% in the alendronate group versus no change (0-0.2%) in the placebo group.(2,3) At the femoral neck, BMD also increased in the alendronate group (2-4.2%) versus a slight loss (0.3-0.4%) in the placebo group.(2,3) Similar positive effects of alendronate were reported from nonrandomized studies that were comprised of 53 postmenopausal women and 24 older men.(4,5) Radial BMD did not change significantly, (2,4,5) and none of the studies showed any sustained clinically significant changes in serum calcium or parathyroid hormone (PTH).On the basis of these studies, we propose that bisphosphonate therapy be considered to improve BMD in those patients with primary hyperparathyroidism who are being followed with observation rather than having them undergo definitive therapy by surgery.