Postoperative zoledronic acid for osteoporosis in primary hyperparathyroidism: a randomized placebo-controlled study

Abstract

Objective: In primary hyperparathyroidism (PHPT) with osteoporosis, bone mineral density (BMD) improves after parathyroidectomy. It is unclear whether combining surgery with postoperative bisphosphonate treatment can further improve bone health. Design: This randomized, placebo-controlled study compared the effects of surgery alone and surgery combined with zoledronic acid on bone metabolism in PHPT with osteoporosis. Methods: Fifty-six patients (f/m 47/9, mean age 68.4 years) with PHPT and osteoporosis were randomized 1–3 months after parathyroidectomy to receive a two-year treatment of zoledronic acid or placebo. Dual-energy X-ray absorptiometry (DXA) and bone turnover markers (N-terminal propeptide of type 1 procollagen, C-terminal telopeptide of type 1 collagen, and alkaline phosphatase) were measured annually during the 2-year follow-up. Results: Two years after parathyroidectomy, BMD was significantly higher in the zoledronic acid (ZOL) group compared with the placebo (PBO) group at the femoral neck (P = 0.045 for Z-score) and lumbar spine (P = 0.039 and 0.017 for T- and Z-scores, respectively). Bone turnover markers were significantly lower in the ZOL group (P < 0.001 for all markers). Of the 18 patients who had received bisphosphonates for >1 year before surgery, BMD improved significantly in the ZOL group both in the femoral neck and lumbar spine (N = 10; all P < 0.001–0.01) but in the PBO group only in the lumbar spine (N = 8, P = 0.03), (P= 0.08-0.95 for between-group changes). Conclusion: BMD increases after parathyroidectomy both with and without zoledronic acid but the increase is significantly higher with postoperative zoledronic acid.

Curative Effect of Prebiotics/Probiotics Preparations Combined with Zoledronic Acid + Calcitriol Regimen on Patients with Primary Osteoporosis and Their Influences on Bone Metabolism Markers

“…It can act on human bones, inhibit bone resorption by inhibiting osteoclasts, induce their apoptosis, and can regulate osteoblasts and osteoclasts. A cellular transcriptional mechanism reduces osteoclast activity and contributes to the optimization of bone turnover status [ 6 , 7 ]. Relevant studies have pointed out that zoledronic acid can interfere with the mevalonate metabolic pathway in osteoclasts, induce osteoclast and monocyte precursor cell apoptosis, reduce osteoclast activity, inhibit bone resorption, and play an antibone role of mass loosening [ 8 ].…”

“…e difference in the above data between the two groups was not markedly significant (P > 0.05). (5) those who are sensitive to the drugs used in this study; (6) patients with other inflammatory diseases; (7) patients with severe gastrointestinal diseases.…”

Bone Turnover Markers: Basic Biology to Clinical Applications

“…BTMs decreased after surgery, independent of the presurgical use of bisphosphonates. A further decrease was observed in patients who received zoledronate after parathyroidectomy ( 376 ).…”

Medical management of primary hyperparathyroidism

“…There were significant increases in BMD of LS (P = 0.039 and 0.017 for T and Z scores, respectively) and FN (P = 0.045 for Z score), as well as reductions in bone turnover markers in the ZOL group compared to placebo. Thus, an increase in BMD was demonstrated after PTX with and without ZOL, but this effect was significantly greater with the use of ZOL postoperatively ( 35 ).In a small case series, denosumab was used to normalize serum calcium levels before PTX in four patients with severe hypercalcemia, demonstrating safety and efficacy ( 36 ).…”