Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Abstract

Background: After parathyroidectomy (PTX), hungry bone syndrome leads to hypocalcemia due to bone remineralization. The aim of this pilot study was to analyze changes in markers of bone metabolism in patients with secondary hyperparathyroidism (sHPT) after PTX and to correlate these markers with bone pain measured with a validated questionnaire. Materials and Methods: All patients who underwent PTX for sHPT between March 2010 and February 2012 at out institution were included in this prospective observational pilot study. At the day before surgery and on the 3rd day thereafter, levels of parathyroid hormone (PTH), calcium, osteocalcin, alkaline phosphatase (AP), bone-specific AP (BAP), tartrate-resistant acid phosphatase 5b (TRAP5b), osteoprotegerin (OPG), sclerostin, fibroblast growth factor 23, and Klotho were measured. Additionally, all patients were requested to answer the Brief Pain Inventory preoperatively and on the 5th postoperative day. Results: A total of 35 patients with a mean age of 49.8 years were analyzed. A significant difference between the pre- and postoperative values could be detected in PTH, calcium, BAP, TRAP5b, and sclerostin. The highest correlation of laboratory markers with bone pain was found for preoperative PTH (r = 0.3), postoperative OPG (r = 0.4), postoperative BAP (r = –0.4), and postoperative Klotho (r = –0.4). Conclusions: The present study revealed significant perioperative changes in PTH, BAP, sclerostin, and TRAP5b after PTX. These markers may serve as laboratory markers to monitor bone metabolism in patients with sHPT. PTH, OPG, and sclerostin were the parameters with the closest correlation to bone pain. However, larger prospective trials with a longer follow-up are required to confirm these results.

Study on the correlation between mineral bone metabolism and CRP in patients with SHPT during perioperative period

“…The results of this study showed that, compared with preoperative, the postoperative levels of BAP and PINP in SHPT patients were significantly increased, and the postoperative levels of CTX and TRAP‐5b were significantly decreased, indicating that PTX can promote bone formation and reduce bone resorption, which can partially explain the obvious reduction of postoperative bone pain symptoms in patients. Schneider's team reported that BAP significantly increased in SHPT patients on the 4th day after surgery, while TRAP‐5b rapidly decreased in a short period, which was consistent with our study results 35 . A longitudinal study involving 31 patients with SHPT found that BAP significantly increased 1 week after PTX, but serum BAP and PINP levels gradually decreased 3 months later 36 .…”

“…Schneider's team reported that BAP significantly increased in SHPT patients on the 4th day after surgery, while TRAP‐5b rapidly decreased in a short period, which was consistent with our study results. 35 A longitudinal study involving 31 patients with SHPT found that BAP significantly increased 1 week after PTX, but serum BAP and PINP levels gradually decreased 3 months later. 36 The Pires team also found a significant decrease in serum BAP in SHPT patients 1 year after PTX, 37 suggesting that the effect of PTX on bone transport status in SHPT patients may change with the passage of postoperative time.…”

Osteocalcin is an Independent Predictor for Hungry Bone Syndrome After Parathyroidectomy

“…In the immediate postoperative period, withdrawal of prolonged elevation of PTH levels attenuates osteoclast activity and bone resorption, whereas an increase in osteoblast activity corresponds to rapid remineralization of the skeleton, which can be seen on bone scintigraphy as increased radioactive isotope uptake known as flare phenomenon [37]. As seen in our study, the osteocalcin level may remain unchanged or elevated during the early postoperative period [38, 39]. In the late postoperative phase, while high‐turnover renal osteodystrophy gradually improves following parathyroidectomy, the osteocalcin level would typically decrease [39, 40].…”

A nomogram prediction model for hungry bone syndrome in dialysis patients with secondary hyperparathyroidism after total parathyroidectomy

“…The ALP activity is of crucial importance to the appropriate bone mineralization. ALP is also the well-recognized biomarker for renal osteodystrophy [ 25 – 27 ]. SHPT patients are mostly associated with metabolic diseases, their serum ALP levels increase in the presence of activated osteoblasts, and the increase level is associated with the severity of bone disease [ 17 , 28 ].…”