ACCELERATED BONE LOSS IN POSTMENOPAUSAL WOMEN WITH MILD PRIMARY HYPERPARATHYROIDISM

OBJECTIVES Osteopenia is regarded as an indication for parathyroidecto my in primary hyperparathyroidism. However, uncertainty exists as to t he extent and degree of the skeletal effects in those with mild diseas e. We sought to determine whether mild primary hyperparathyroidism aff ects the rate of bone loss in postmenopausal women. DESIGN Prospective 2-year comparison of rates of bone loss throughout the skeleton in 17 post-menopausal women with untreated mild asymptomatic primary hyperp arathyroidism, and 48 age-matched, eucalcaemic controls. RESULTS The w omen with primary hyperparathyroidism had a greater annual rate of los s of bone mineral density (BMD) of the total body (mean+/-SE, primary hyperparathyroidism -1 . 15+/-0 . 31%, controls -0 . 39+/-0 . 10%; P = 0 . 04) and its spine subregion (primary hyperparathyroidism -2 . 08/-0 . 88%, controls 0 . 04+/-0 . 35%; P = 0 . 02). Lumbar spine BMD te nded to decline in the primary hyperparathyroidism group (-0 . 35+/-0 . 33%) in contrast to the control group (+0 . 28+/-0 . 22%) (P = 0 . 1 0). There were no significant differences between the groups in rates of change of BMD in the legs or the proximal femur. In the primary hyp erparathyroidism group, the rate of total body bone loss in the eight women known at study entry to have had long-standing (> 5 years) prima ry hyperparathyroidism was -1 . 52+/-0 . 61%/year, similar to that of the whole group. CONCLUSION Primary hyperparathyroidism is associated with an increased rate of loss of total body bone mineral density in p ost-menopausal women. Prolonged disease duration is therefore likely t o be associated with an increasing risk of osteopenia, such that skele tal surveillance and interventions designed to reduce bone loss should be considered.