No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial

Rolighed, Lars; Rejnmark, Lars; Sikjær, Tanja; Heickendorff, Lene; Vestergaard, Peter; Mosekilde, Leif; Christiansen, Peer

doi:10.1530/eje-14-0940

Cited by 24 publications

(20 citation statements)

References 41 publications

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“…Some guidelines advise the use of vitamin D supplements before the operation ( 12 – 14 ). Recently, several studies analysed the impact of vitamin D correction prior to parathyroidectomy, found that it had an insignificant impact on the outcomes, and suggested that correction of vitamin D deficiency should not delay the operation ( 15 , 16 ). Moreover, theoretically the use of bisphosphonates could reduce the rate of HBS, because they inhibit osteoclasts and reduce bone demineralization.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

Jakubauskas¹,

Beiša²,

Strupas³

2018

AML

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Background.Around 13% of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT) postoperatively develop a condition known as the hungry bone syndrome (HBS). Although the condition is quite prevalent, the research in this field is very limited. The aim of our study was to determine possible risk factors of developing HBS after parathyroidectomy for PHPT.Materials and methods.In this study we enrolled patients who underwent parathyroidectomy for PHPT from January 2005 to December 2016 and performed a retrospective analysis. We used the definition of HBS as hypocalcaemia with normal or elevated PTH values. Patients were divided into two groups by the postoperative HBS prevalence: patients with postoperative HBS and those without postoperative HBS.Results.In all, 94 patients were included into the final analysis. We found that patients who developed HBS more often underwent parathyroidectomies simultaneously with a thyroid surgery, underwent longer operations (73.9 ± 41.7 vs. 102.4 ± 44.8 minutes; p = 0.001), and had heavier parathyroid glands removed (0.6 (0.3–8.0) vs. 0.8 (0.15–14.0) g; p = 0.041). Also, these patients had higher preoperative PTH values (15.3 (6.1–63.7) vs. 22.4 (9.2–47.8) pmol/l; p = 0.003). From the ROC curve of the preoperative PTH values and the development of the hungry bone syndrome (AUC = 0.721 (95% CI 0.59–0.85); p = 0.003) we found a 45 pmol/l PTH cut-off value that shows a 90% tendency to develop postoperative HBS.Conclusions.Patients undergoing longer parathyroidectomies and those with heavier removed parathyroid glands tend to develop HBS. A preoperative PTH value higher than 45 pmol/l determines an over 90% risk of developing HBS.

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Section: Discussionmentioning

confidence: 99%

Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

Jakubauskas¹,

Beiša²,

Strupas³

2018

AML

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“…Rolighed and colleagues 167 recently reported the results of a randomized, placebo-controlled study, which investigated whether vitamin D supplementation improved QOL in PHPT. Subjects given 2,800 IU of cholecalciferol for 26 weeks before and 26 weeks following parahyroidectomy demonstrated significant improvements in 25-hydroxyvitamin D levels.…”

Section: Quality Of Lifementioning

confidence: 99%

Primary hyperparathyroidism

Bilezikian

Cusano

Khan

et al. 2016

Nat Rev Dis Primers

215

166

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Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes. Hypercalcaemia is the biochemical hallmark of PHPT. Usually, the concentration of PTH is frankly increased but can remain within the normal range, which is abnormal in the setting of hypercalcaemia. Normocalcaemic PHPT, a variant in which the serum calcium level is persistently normal but PTH levels are increased in the absence of an obvious inciting stimulus, is now recognized. The clinical presentation of PHPT varies from asymptomatic disease (seen in countries where biochemical screening is routine) to classic symptomatic disease in which renal and/or skeletal complications are observed. Management guidelines have recently been revised to help the clinician to decide on the merits of a parathyroidectomy or a non-surgical course. This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT.

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“…A total of 69 full-text articles were studied for eligibility. Fifteen were found ineligible; nine of these were focused on pharmaceutical agents outside the scope of this review [five vitamin-D supplementation and calcium (12, 70–73), two octreotide (10, 11), one hormone replacement therapy (6), one Strontium Ranelate (9)]; two were review articles (74, 75); two had no data on effect of the included drugs (76, 77); one had a main focus other than medical treatment of primary hyperparathyroidism (78); and one was found incomparable to the remaining studies due to incoherent reporting and few subjects (79). Fifty-four articles were thus included in this review.…”

Section: Resultsmentioning

confidence: 99%

Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

et al. 2017

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IntroductionPrimary hyperparathyroidism is increasingly an asymptomatic disease at diagnosis, but the recognized guidelines for management are based on evidence obtained from studies on patients with symptomatic disease, and surgery is not always indicated. Other patients are unable to undergo surgery, and thus a medical treatment is warranted. This systematic review provides an overview of the existing literature on contemporary pharmaceutical options available for the medical management of primary hyperparathyroidism.MethodsDatabases of medical literature were searched for articles including terms for primary hyperparathyroidism and each of the included drugs. Data on s-calcium, s-parathyroid hormone, bone turnover markers, bone mineral density (BMD) and hard endpoints were extracted and tabulated, and level of evidence was determined. Changes in s-calcium were estimated and a meta-regression analysis was performed.ResultsThe 1,999 articles were screened for eligibility and 54 were included in the review. Weighted mean changes calculated for each drug in s-total calcium (mean change from baseline ± SEM) were pamidronate (0.31 ± 0.034 mmol/l); alendronate (0.07 ± 0.05 mmol/l); clodronate (0.20 ± 0.040 mmol/l); mixed bisphosphonates (0.16 ± 0.049 mmol/l); and cinacalcet (0.37 ± 0.013 mmol/l). The meta-analysis revealed a significant decrease of effect on s-calcium with time for the bisphosphonates (Coef. −0.049 ± 0.023, p = 0.035), while cinacalcet proved to maintain its effect on s-calcium over time. Bisphosphonates improved BMD while cinacalcet had no effect.DiscussionThe included studies demonstrate advantages and drawbacks of the available pharmaceutical options that can prove helpful in the clinical setting. The great variation in how primary hyperparathyroidism is manifested requires that management should rely on an individual evaluation when counseling patients. Combining resorptive agents with calcimimetics could prove rewarding, but more studies are warranted.

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No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial

Cited by 24 publications

References 41 publications

Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism

Primary hyperparathyroidism

Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

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