A case of primary hyperparathyroidism with marked changes in bone mineral density and geometry after parathyroidectomy

Abstract

Primary hyperparathyroidism (pHPT) is an endocrine disorder that causes secondary osteoporosis and various bone lesions, such as brown tumor and osteitis fibrosa. Patients with pHPT have reduced bone mineral density (BMD), especially at the cortical bone, whereas bone mass is relatively well preserved in cancellous bone [1–4]. Several studies have suggested that pHPT is associated with an increased risk of vertebral and forearm fractures [5–7]. Numerous studies have demonstrated that pHPT patients regained BMD, mainly at trabecular sites, after parathyroidectomy (PTX) [4,7–10]. Although parathyroid hormone (PTH) affects bone geometry [11] and our previous study indicated that bone geometry indices by peripheral quantitative computed tomography (pQCT) are markedly changed in female pHPT patients [12], it remains unknown how bone geometry is affected by PTX. We present a case of pHPT with severe osteoporosis as well as marked bone lesions including brown tumor. Changes in bone geometry as well as marked increases in BMD were observed after PTX in this patient. Case report