Preoperative Serum Osteocalcin may Predict Postoperative Elevated Parathyroid Hormone in Patients with Primary Hyperparathyroidism

Abstract

Preoperative OC may help to predict risk of POePTH in patients with PHPT. Research with longer follow-up in patients with no known baseline chronic kidney disease stratified by high versus normal preoperative serum creatinine is recommended.

Factors influencing pre‐operative urinary calcium excretion in primary hyperparathyroidism

“…The reason for the association between osteocalcin and CCCR may be a multifactorial increase in the rate of bone turnover, leading to serum Ca elevation . In contrast to Moosgaard et al., we found no associations either between BMD and 24‐h U Ca or between BMD and CCCR, perhaps because our pre‐operative evaluations were carried out at an earlier stage of PHPT: BMD changes occur slowly, whereas osteocalcin allows to monitor changes in bone mineralization at 3‐monthly intervals …”

“…BMD changes occur slowly, whereas osteocalcin allows to monitor changes in bone mineralization at 3-monthly intervals. 24,25 In a population-based analysis published by Rathod et al, 10 In addition to the parameters listed in the table, the model contained the variable sex. As the model also contained sex-testosterone interaction, the estimated effect of sex depends on the value of testosterone and is not described in the table for reasons of simplicity.…”

The impact of vitamin D status on hungry bone syndrome after surgery for primary hyperparathyroidism

“…BMD neck was a significant risk factor for the development of HBS in univariate, but not in the multivariable analysis. It has been argued that BMD may be an imperfect marker, as BMD changes occur slowly (7). Moreover, ostecalcin had no significant impact on the development on HBS in multivariable analysis, although osteocalcin has been reported to be a specific serum marker of bone (7).…”

“…The underlying reason is assumed to be the normalization of high circulating iPTH levels, followed by enhanced bone formation with increased skeletal Ca requirement. Risk factors being discussed for HBS are advanced age, higher preoperative serum Ca, iPTH, alkaline phosphatase (ALP) and osteocalcin, as well as decreased serum magnesium and albumin levels (6,7). Previous studies have examined the relationship between adenoma size and weight and postoperative serum Ca with conflicting results (8,9).…”

Surgical Aspects of Primary Hyperparathyroidism

“…Management of hungry bone syndrome consists of aggressive (often intravenous) supplementation of calcium, calcitriol, and magnesium. (127,130)…”