Longitudinal changes in bone density in hyperparathyroidism.

Primary hyperparathyroidism (HPTH) is a known risk factor for cortical bone loss. The primary objective of this study was to examine the time course a nd location of changes in bone mass within the first year after parathyroid ectomy (PTX). The secondary goal was to evaluate the efficacy of combined e strogen therapy and parathyroidectomy in postmenopausal women. Thirty-two s ubjects with primary HPTH participated in a prospective, longitudinal study for at least 1 yr. Twenty-seven subjects underwent PTX, while five receive d no therapy (control). Among the PTX patients, 21 were postmenopausal wome n, and 8 of these women also received estrogen. Subjects had serial measure ments of parathyroid hormone levels, serum chemistries, and bone density at multiple sites. Among all PTX patients, lumbar spine, hip, and whole body bone mineral content increased significantly (3.8-6%; p < 0.005) at 12 mo, with most of the increments observed by 3 mo. In postmenopausal women, estr ogen treatment resulted in higher increments in the femoral neck (8.6 +/- 2 % vs 4.9 +/- 1.2%, respectively; p = 0.07) and the whole body (6 +/- 2% vs 2.4 +/- 1.6 %, respectively; p = 0.07). In HPTH, early and generalized incr ements in bone mass follow PTX, and the combination of surgery with estroge n therapy may be superior to surgery without estrogen treatment. A randomiz ed, controlled trial including PTX, estrogen, and a combination of the two is needed to determine the optimal therapy in postmenopausal women.