Trabecular Bone Score, Bone Mineral Density and Bone Markers in Patients with Primary Hyperparathyroidism 2 Years After Parathyroidectomy

Abstract

Following a parathyroidectomy there is a bone mineral density (BMD) improvement in patients with primary hyperparathyroidism. However, data of bone microarchitecture are scarce. Trabecular bone score (TBS) estimates bone microarchitecture and could provide valuable information in those patients. The aim of this study is to assess TBS changes 2 years after successful surgery in a group of patients with primary hyperparathyroidism and correlate these results with changes in BMD and bone turnover markers. This is a prospective study including 32 patients. In all participants BMD and TBS were measured, before and 24 months after surgery. Biochemical data: serum calcium, PTH, 25-OH-vitamin D, beta-crosslaps, bone alkaline phosphatase, and osteocalcin. 25 female and 7 male patients, mean age 64.6±12.4 years, were included in the study. At baseline, BMD was low at: lumbar spine (T-score −2.19±1.31), total hip (−1.33±1.12), femoral neck (−1.75±0.84), and distal one-third radius (−2.74±1.68). Baseline TBS showed partially degraded microarchitecture (1.180±0.130). After parathyroidectomy lumbar spine BMD increased significantly (5.3±13.0%, p<0.05), as well as total hip (3.8±8.8%, p<0.05). There was an increase in TBS, but this was not significant. There was a correlation between TBS and BAP at baseline (rs=0.73; p<0.01) and TBS and BAP 2 years after surgery (rs=0.57, p<0.05). Although bone density improves 2 years after surgery in patients with primary hyperparathyroidism and there is a restoration of bone turnover markers, TBS is not completely restored. These results remark the necessity of longer periods of study, to confirm if bone microarchitecture could be completely restored after surgery.

Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

“…In patients who underwent a PTX procedure, TBS changes were close to significance. Similarly, other recent studies of PHPT patients reported no significant changes in TBS following PTX [30][31][32]. The present results, including greater percent changes in LS and TH-BMD in the PTX group as compared to the Dmb group, suggest that magnitudes of gains in BMD rather than TBS reflect a large portion of the efficacy of PTX, with a strong association with reduced fracture risk.…”

Evaluation for Primary Hyperparathyroidism in Patients Who Present With Nephrolithiasis

“…nephrolithiasis, protection or improvement in bone mineral density, decreased fracture risk, and lower overall cost of care than observation. 11,12,[19][20][21][22] Continuing medical education for primary care providers in training and in practice is a potential strategy to improve rates of surgical referral for PHP. Systems-based interventions to improve appropriate evaluation and referral should be considered to address these deficiencies.…”

Does Baseline PTH Influence Recovery of Bone Mineral Density, Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism

“…In a study of 34 subjects following parathyroidectomy, there was no significant increase in BMD at the femoral neck (10). In another study by Tay et al, in obese and non-obese subjects following curative parathyroid surgery, significant improvements in BMD at the lumbar spine and femoral neck were observed (18).…”

“…Trabecular bone score (TBS) is a novel tool that can be applied to DXA images and utilizes graylevel textural analysis, to predict trabecular microarchitecture (19). Studies in cadaveric bones have shown significant correlations between TBS and 3D trabecular microarchitecture measurements by microcomputed tomography and fracture risk (10). In a study by Silva There was a significant decrease in bone turnover markers including CTX, P1NP, ALP and osteocalcin during follow up.…”

“…In a retrospective study of Indian patients with PHPT,about three-fourth remained symptom free following curative surgery (9). In a study by Miguel et al (10) involving 32 subjects followed up for a period of 2 years after curative parathyroid surgery, there was an improvement in bone mineral density with a restoration of bone turnover markers(BTMs). Moreover, despite the availability of bone turnover markers (BTMs) and TBS in current day clinical practice, serial changes in these parameters following surgery are not well studied.…”