THE SKELETAL EFFECTS OF PRIMARY HYPERPARATHYROIDISM

Primary hyperparathyroidism (PHPT) is a common endocrine disorder whic h occurs most frequently in post-menopausal women and is characterized by mild, stable, and often asymptomatic hypercalcaemia. Chronic parat hyroid hormone excess stimulates bone remodelling by inducing producti on by osteoblasts of soluble factors which stimulate both bone formati on and osteoclastic bone resorption. Studies of bone mineral density ( BMD) in PHPT suggest that bone loss is accelerated, leading to osteope nia, particularly at sites of cortical bone. Studies of fracture incid ence in PHPT have produced conflicting results. Interventional studies have demonstrated that both parathyroid adenomectomy and estrogen rep lacement therapy increase BMD in patients with PHPT. Patients with PHP T should undergo BMD measurement, and receive treatment designed to st abilize bone mass if there is evidence of either osteopenia or acceler ated bone loss.