Pre- and postoperative bone metabolism of primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a well-known indicator of severe bone loss. However, the recovery process of bone mineral density after surgery in PHPT patients is not sufficiently clear. We examined postoperative bone metabolism in 24 PHPT patients. Patients and methods - Subjects were 24 patients with PHPT upon whom we per formed parathyroidectomy in the Department of Surgery II, Fukushima Medical University. Mean age was 54.2 years and the male-to-female ratio was 10:14 ; mean time of follow-up was 27.3 months. Patients were divided histopathol ogically into 16 adenomas and eight hyperplasias, and classified by heredit y into seven familial (six, MEN 1; one, MEN 2) and 17 sporadic types. Bone mineral density was measured by dual energy X-ray absorptometry (DXA) and d igital image processing (DIP). Age-matched values of these parameters were obtained. Serum bone metabolic parameters; ionized calcium (CaF), phosphoru s, intact PTH (iPTH), c-PTH, ALP, osteocalcin (OC) and PTHrP were measured. Results - PHPT patient preoperative bone mineral densities were significant ly lower than those of healthy controls. Those by DIP method were lower tha n those by DXA. High CaF, iPTH, OC and ALP levels were indicated before sur gery, but all parameters immediately became normal. Longitudinal bone miner al density changes of asymptomatic cases increased more than those of patie nts with renal stone and/or ostitis fibrosa. In adenoma cases, tumor weight s were significantly inversely, which correlated with preoperative DTP bone density measurements. Conclusion - Preoperative PHPT patients showed decreased bone density; bone loss in symptomatic cases was especially prominent compared to asymptomati c cases. Most PHPT patients had not completed the BMD recovery after surger y, so even asymptomatic and mild PHPT patients should undergo parathyroidec tomy to minimize irreversible bone loss. (C) 2000 Editions scientifiques et medicales Elsevier SAS.