Effects of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women With Primary Hyperparathyroidism

Orr-Walker, Brandon; Evans, Margaret C.; Clearwater, Judy; Horne, Anne; Grey, Andrew; Reid, Ian R.

doi:10.1001/archinte.160.14.2161

Cited by 84 publications

(40 citation statements)

References 27 publications

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“…In a 4-year follow-up of hormone replacement therapy, cortical BMD improved [19], since it takes more time to recover lost BMD in cortical sites than in trabecular sites. Therefore, BMD needs to be followed for longer periods of EHDP therapy in elderly PHPT patients.…”

Section: Discussionmentioning

confidence: 99%

A Strategy for the Management of Elderly Women with Primary Hyperparathyroidism: A Comparison of Etidronate Therapy with Parathyroidectomy

Horiuchi¹,

Onouchi²,

Inoue³

et al. 2002

Gerontology

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Objective: To evaluate the efficacy of etidronate (EHDP) on lumbar spine bone mineral density (LSBMD) and total bone mineral density (TBMD) in elderly women with primary hyperparathyroidism (PHPT), we compared changes in LSBMD and TBMD between patients treated by EHDP therapy and parathyroidectomy (PTX). Subjects and Methods: Twenty-two PHPT patients were enrolled and randomized into two groups; 9 received EHDP and 13 underwent PTX. All patients were followed up for 1 year by measuring LSBMD, TBMD, serum calcium, inorganic phosphate, parathyroid hormone, 1,25-dihydroxyvitamin D, serum alkaline phosphatase, intact osteocalcin, urinary pyridinoline (U_pyd) and urinary deoxypyridinoline (U_dpd). The presence of spinal fractures was evaluated by X-ray photography before and after treatment. Results: EHDP treatment produced a significant increase in LSBMD of 10% compared with pretreatment levels after 1 year (p < 0.03, compared to baseline), while PTX produced a significant increase in LSBMD of 20% compared to pretreatment levels (p < 0.01). However, TBMD remained unchanged for 1 year after both EHDP administration and PTX. Among biochemical bone turnover markers, EHDP administration resulted in significant decreases in alkaline phosphatase by 78%, U_pyd by 64% and U_dpd by 37% after 12 months compared with the pretreatment levels (p < 0.05) and intact osteocalcin by 67% after 6 months (p < 0.05). There were no differences in the fracture rate between the EHDP and PTX groups during 1 year. Conclusion: EHDP administration results in a somewhat lower increase in LSBMD than that following PTX and suppresses bone formation and resorption in elderly PHPT patients for 1 year. We conclude that PTX is preferable to EHDP therapy for the management of elderly PHPT patients; however, EHDP administration should also be considered for elderly patients with many complications or who are unfit for surgery.

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Section: Discussionmentioning

confidence: 99%

A Strategy for the Management of Elderly Women with Primary Hyperparathyroidism: A Comparison of Etidronate Therapy with Parathyroidectomy

Horiuchi¹,

Onouchi²,

Inoue³

et al. 2002

Gerontology

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“…These effects are maintained for up to 4 years [Orr-Walker et al 2000]. Two nonrandomized studies have examined the effects of HRT versus parathyroidectomy in postmenopausal women with PHPT [Diamond et al 1996;Guo et al 1996].…”

Section: Medical Management Of Phptmentioning

confidence: 99%

Review: New perspectives in the management of primary hyperparathyroidism

Ayuk

Cooper

Gittoes

2010

Therapeutic Advances in Endocrinology

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Primary hyperparathyroidism (PHPT) is a biochemical syndrome caused by the inappropriate or unregulated overproduction of parathyroid hormone, leading to hypercalcaemia. It was previously considered a relatively rare disorder, with clinical manifestations dominated by renal and/or bone disease. However, in modern times the diagnosis is most frequently recognized coincidentally on biochemical testing in patients evaluated for unrelated complaints. Parathyroidectomy is the only curative treatment for PHPT, with improved outcomes in symptomatic patients following this procedure. However, surgical intervention in patients with no clear clinical features remains controversial. The National Institutes for Health (NIH) have developed consensus guidelines giving specific indications for when surgery is recommended in patients with asymptomatic PHPT. This article examines the impact of treatment on asymptomatic PHPT, focusing on bone disease, neurocognitive function, quality of life, cardiovascular disease and mortality. Medical treatment options, including bisphosphonates and cinacalcet, are also discussed.

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“…In addition, 25% of patients with mild asymptomatic disease have progression of their disease over a 10-year period [1]. Estrogen therapy has been shown to improve bone mineral density in postmenopausal women with primary HPT [2]. Controlled trials using bisphosphonates have also reported an increase in bone density of 2% to 6% per year [3,4].…”

Section: Introductionmentioning

confidence: 99%