Quantitative ultrasound assessment of bone in patients with primary hyperparathyroidism

Minisola, Salvatore; Rosso, R.; Scarda, A.; Pacitti, M. T.; Romagnoli, Elisabetta; Mazzuoli, G. F.

doi:10.1007/bf00298582

Cited by 29 publications

(12 citation statements)

References 20 publications

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“…Before surgery, both DXA and QUS measurements were significantly reduced in patients with PHPT with respect to the control group. In agreement with previous studies [9][10][11]20], we have found a relatively greater reduction in bone mass at skeletal bone sites where cortical bone dominates, such as the forearm. This finding corresponds to histomorphometric data, which have documented a preferential involvement of cortical bone with a relative preservation of cancellous bone [3][4][5][6][7].…”

Section: Discussionsupporting

confidence: 93%

“…Yet studying patients with other metabolic bone diseases may not only provide us with information about the usefulness of QUS in these diseases, but may also help in the understanding of the process by which sound interacts with bone tissue. In our patients, QUS parameters, namely BUA, showed more alterations than reported by Minisola et al [20]. This discordance may be explained by the difference in clinical characteristics of the two study populations, our patients being on average about 7 years older.…”

Section: Discussioncontrasting

confidence: 83%

“…However, to our knowledge only a cross-sectional study [20] has investigated QUS parameters at the heel in patients with PHPT, and no data exist in the literature on the changes in QUS after parathyroidectomy.…”

Section: Introductionmentioning

confidence: 91%

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Quantitative Ultrasound and Bone Mineral Density in Patients with Primary Hyperparathyroidism Before and after Surgical Treatment

Gonnelli

Montagnani

Cepollaro

et al. 2000

Osteoporosis International

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The aim of this study was to assess the pattern of ultrasound (QUS) parameters and bone mineral density at different skeletal sites in patients with primary hyperparathyroidism (PHPT) before and after surgical treatment. In 22 patients (age range 28-74 years) with PHPT we measured speed of sound (SOS), attenuation (BUA) and Stiffness at the calcaneus, amplitude-dependent speed of sound (AD-SoS) at proximal phalanges, and bone mineral density at lumbar spine (BMD-LS) and at the mid-radius (BMD-MR) and ultra-distal radius (BMD-UDR) before, 1 and 2 years after surgical operation. Twenty-two age- and sex-matched healthy subjects provided control data. Before surgery, all parameters apart from SOS were significantly lower in PHPT patients than in controls. At the end of the study period, BMD-LS increased by 7.0%, BMD-UDR by 7.4% and BMD-MR by 11.0%. The changes in ultrasound parameters after surgery were lower (0.44% for SOS, 2.2% for BUA, 3.3% for Stiffness and 2.6% for AD-SoS); however, the increase was statistically significant (p < 0.05 and p < 0.01, respectively) only for Stiffness and AD-SoS. Our results indicate that parathyroidectomy increases both axial and appendicular BMD and influences QUS parameters differently at the calcaneus and at the phalanges. The combined use of BMD and QUS could improve the assessment of skeletal status in patients with PHPT before and after surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 83%

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Quantitative Ultrasound and Bone Mineral Density in Patients with Primary Hyperparathyroidism Before and after Surgical Treatment

Gonnelli

Montagnani

Cepollaro

et al. 2000

Osteoporosis International

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“…In a recent study comparing different densitometric methods in a series of predominantly female patients with primary hyperparathyroidism, radial cortical-rich sites appeared to be more sensitive than spine or femoral DXA measurements [21]. The similarity of these results obtained in patients affected by primary hyperparathyroidism with our own data supports the hypothesis that also in uremic osteopenia the prolonged PTH excess, i.e., the secondary hyperparathyroidism, plays a major pathogenetic role.…”

Section: Discussionsupporting

confidence: 83%

Volumetric Bone Density and Geometry Assessed by Peripheral Quantitative Computed Tomography in Uremic Patients on Maintenance Hemodialysis

Russo

Taccetti

Caneva

et al. 1998

Osteoporosis International

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The aim of this study was to establish, by means of peripheral quantitative computed tomography (pQCT) at the distal radius, the existence of cortical and/or trabecular osteopenia, and to assess the integrity of bone geometry in uremic patients undergoing maintenance hemodialysis. Our results show a clearcut selective reduction in volumetric cortical density, more evident in women (p = -0.0001) than men (p = 0.030), which appears to be independent of age and menopausal status. Trabecular density was not significantly changed in either sex. Cortical density of the patients correlated inversely with age (p = 0.003), duration of dialysis (p = 0.002) and parathyroid hormone (PTH) levels (p = 0.03). Trabecular density correlated only with age. Normally, cortical density is age-dependent and its reduction is accompanied by compensatory geometry changes. Compared with control subjects, in our female patients both cortical area and cortical thickness were reduced (p = 0.02 and 0.008), while cross-sectional area did not change (p = 0.67). Conversely, in the males only cross-sectional area was reduced (p = 0.02). In conclusion, in uremic patients we observed a selective cortical osteopenia, more evident in the female sex, and a sex-specific pattern of geometry impairment, with resultant apparent increased bone fragility in the uremic women. We suggest that the prolonged PTH excess could be responsible, directly and/or interacting with estrogen deficiency.

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“…In agreement with previous data [4,23,[26][27][28], we found a significant reduction of AD-SoS in both PHPT and OP patients with respect to healthy subjects. However, ADSoS did not differ significantly between PHPT and OP patients, suggesting that speed of sound was not influenced by the different histomorphometric pattern characterizing these two metabolic bone diseases [29].…”

Section: Discussionsupporting

confidence: 82%

Graphic Trace Analysis of Ultrasound at the Phalanges May Differentiate Between Subjects with Primary Hyperparathyroidism and with Osteoporosis: A Pilot Study

et al. 2002

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Bone loss characterizes both primary hyperparathyroidism (PHPT) and osteoporosis (OP) but with a different histologic pattern, and this could partially explain the different fracture incidence in these two populations. Quantitative ultrasound (QUS), influenced by bone structural parameters other than bone mineral density (BMD), could evidence these differences, opening new perspectives in the evaluation of patients with metabolic bone diseases. The aim of the present study was to investigate the usefulness of QUS graphic trace parameters, assessed at the phalanx, in discriminating between PHPT bone disease and osteoporosis. We studied 34 patients with PHPT (mean age 59.7 +/- 12.7 years), 35 patients with OP (mean age 60.6 +/- 7.1 years) and 34 healthy subjects as controls (mean age 59.1+/- 9.4 years). In all subjects QUS measurements were performed at the phalanx with a Bone Profiler (IGEA, Italy), obtaining the amplitude-dependent speed of sound (AD-SoS), fast wave amplitude (FWA), signal dynamic (SDy), bone transmission time (BTT) and ultrasound bone profile index (UBPI). Moreover, serum calcium, phosphorus, parathyroid hormone (PTH), bone isoenzyme of alkaline phosphatase (B-ALP) and ionized calcium were measured in all subjects in the morning under fasting conditions. In PHPT patients BTT was correlated with PTH, ionized calcium and B-ALP levels (r = -0.47, -0.57 and -0.44, respectively; p < 0.01), whereas FWA, SDy and UBPI correlated only with B-ALP (r = -0.43, -0.46 and -0.50, respectively; p <0.01). Moreover, FWA, SDY and UBPI were significantly (p<0.01) lower and BTT significantly (p<0.001) higher in OP than in PHPT patients. UBPI, BTT, FWA and the BTT/FWA ratio, but not SDy, were able to discriminate between the two groups (area under the curve =0.66, 0.69, 0.67 and 0.81, respectively). Our findings show that ultrasound signal parameters are differently influenced by bone changes characterizing primary hyperparathyroidism or osteoporosis. This suggests that the QUS signal could be a useful instrument in discriminating and studying some of the bone alterations typical of metabolic bone diseases.

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Quantitative ultrasound assessment of bone in patients with primary hyperparathyroidism

Cited by 29 publications

References 20 publications

Quantitative Ultrasound and Bone Mineral Density in Patients with Primary Hyperparathyroidism Before and after Surgical Treatment

Quantitative Ultrasound and Bone Mineral Density in Patients with Primary Hyperparathyroidism Before and after Surgical Treatment

Volumetric Bone Density and Geometry Assessed by Peripheral Quantitative Computed Tomography in Uremic Patients on Maintenance Hemodialysis

Graphic Trace Analysis of Ultrasound at the Phalanges May Differentiate Between Subjects with Primary Hyperparathyroidism and with Osteoporosis: A Pilot Study

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