Effect of Bone Mineral Density and Parathyroidectomy on Fracture Risk in Primary Hyperparathyroidism

VanderWalde, Lindi; Liu, In‐Lu Amy; Haigh, Philip I.

doi:10.1007/s00268-008-9720-8

Cited by 45 publications

(35 citation statements)

References 24 publications

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“…[10][11][12] The procedure also leads to regression of brown tumors. 35,36 VanderWalde et al 10 reported that patients who underwent parathyroidectomy compared with those who did not had a reduced risk of fracture regardless of age, or calcium or PTH level.…”

Section: Discussionmentioning

confidence: 95%

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Skeletal Lesions in Primary Hyperparathyroidism

Zhang

et al. 2015

The American Journal of the Medical Sciences

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Section: Discussionmentioning

confidence: 95%

“…There is no doubt that parathyroidectomy is the first choice in OFC management; however, there is debate about whether orthopedic intervention is also necessary. [10][11][12] The ideal diagnostic and orthopedic therapeutic approach requires further research.…”

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confidence: 99%

Skeletal Lesions in Primary Hyperparathyroidism

Zhang

et al. 2015

The American Journal of the Medical Sciences

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“…A case control study demonstrates a correlation between age, lumbar spine BMD and vertebral fracture with a strong correlation of BMD at the lumbar spine and PHPT: 74 another retrospective cohort study demonstrates in multivariate analysis how parathyroidectomy was independently associated with decreased fracture risk. 75 There are few studies comparing the effects of PHPT on the trabecular bone using different diagnostic tools in different skeleton sites such as micro computed tomography associated with bone biopsy or hystomorphometric studies. All patients with PHPT showed, at histomorphometric studies, an increased endosteal resorption while studies with microtomography showed an alteration of bone architecture in patients with severe PHPT.…”

Section: Skeletal Manifestationmentioning

confidence: 99%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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“…Almost 15% of patients have vertebral osteopenia and 2% have osteitis fibrosa cystica. PHPT may be associated with rheumatic conditions, such as gout and pseudogout [24,25].…”

Section: Presentation and Clinical Formsmentioning

confidence: 99%

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Alhefdhi¹

2015

Surgery

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Review ArticleOpen Access IntroductionPrimary hyperparathyroidism (PHPT) is defined by an abnormal increase in the intrinsic activity of the parathyroid gland(s) that result in elevated parathyroid hormone (PTH) levels [1,2]. It is one of the most common endocrine disorders and is the most common cause of hypercalcemia. PHPT is one of the most common endocrine disorders and is the most common cause of hypercalcemia, which increases morbidity and mortality that result from cardiovascular, renal, and musculoskeletal pathologies. PHPT affects 1 in 500 females and 1 in 2,000 males aged >40 years, with a peak incidence in post-menopausal women. In the US, Europe, and Australia, the reported estimated incidence rates range from 25 to 30 per 100,000 person years, and the prevalence range from 1 to 21 per 1,000 individuals [1][2][3][4].PHPT has been a recognizable disease since the 1920s in both Europe and the US [5]. The first parathyroidectomy was performed in 1925 by Felix Mandl in Vienna, Austria; since then, the diagnosis and management of PHPT have progressed [5]. The purpose of this article is to review the current trends of PPT presentation, work-up, and management. Anatomy and PhysiologyHumans typically have four parathyroid glands located at the posterior capsule of the thyroid gland; in up to 15% of individuals have more than four and up to 3% have three identifiable glands [6]. The superior parathyroid glands arise from the IV pharyngeal pouch and migrate to the cephalad thyroid gland; they are usually located at the cricothyroid junction, 1 cm from the recurrent laryngeal nerve and the inferior thyroid artery. Inferior parathyroid glands arise from the III pharyngeal pouch and migrate caudally with the thymus; they are usually located on the posterolateral aspect of the inferior pole of the thyroid gland. Normal parathyroid glands are yellow or brown in color, oval in shape, 3-7 mm in length, and 30-40 mg in weight [7,8].A parathyroid gland consists of chief cells, oxyphilic cells, a thin fibrous capsule, and a network of adipose tissue, blood vessels, and glandular parenchyma [8]. Chief cells secrete PTH, which consists of 84 amino acid polypeptides. The normal serum PTH level range is 15-72 pg/mL, with a half-life of 2-4 min. Seventy percent of PTH metabolism occurs in the liver and 30% in the kidneys [9][10][11]. PTH is regulated by serum calcium, phosphorus, and vitamin D metabolites. The total normal calcium level should be 8.8-10.2 mg/dL (ionized calcium 2.2-2.6 mmol/L) to ensure optimum physiological functions [9][10][11]. PTH levels are inversely proportional to serum calcium levels, as high serum calcium levels decrease PTH release [5][6][7] and low serum calcium levels increase PTH secretion. This relationship enhances renal tubular calcium reabsorption, urinary phosphate excretion, osteoclastmediated bone resorption, and the conversion of 25-hydroxyvitamin D3 into 1,25-hydroxyvitamin D3, which increases calcium absorption from the bowel [9-11]. EtiologyNinety-five percent of PHPT cases are spora...

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Effect of Bone Mineral Density and Parathyroidectomy on Fracture Risk in Primary Hyperparathyroidism

Abstract: Parathyroidectomy decreases the risk of fracture in patients with normal, osteopenic, and osteoporotic bones. The largest impact from parathyroidectomy is in patients with osteoporosis. The highest risk of fracture is in non-blacks and in patients with osteoporosis.

Cited by 45 publications

References 24 publications

Skeletal Lesions in Primary Hyperparathyroidism

Skeletal Lesions in Primary Hyperparathyroidism

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

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