Abstract
PurposeAfter successful surgery for primary hyperparathyroidism, bone mineral density (BMD) does not improve equally in all patients. As no trial has so far aimed to influence normalization of BMD, it was the goal of this investigation to determine whether pharmacological treatment is effective in improving regain of BMD after successful parathyroidectomy in patients with preoperatively diagnosed osteoporosis or osteopenia and to evaluate when treatment may be indicated.MethodsIn this randomized, placebo-controlled, double-blind trial, 52 patients were treated with strontium ranelate 2 g daily + 1000 mg calcium + 800 IU vitamin D (strontium group; SG) or with 1000 mg calcium + 800 IU vitamin D alone (placebo group; PG) for 1 year. The main outcome measures were BMD (lumbar spine, femoral neck, radius) and bone turnover markers.ResultsThe baseline characteristics were similar in both groups. Absolute BMD (1.007 ± 0.197 vs. 0.897 ± 0.137 g/cm2; p = 0.024) and both relative (9.94 vs. 3.94%; p < 0.001) and absolute (0.09 ± 0.06 vs. 0.03 ± 0.04 g/cm2; p < 0.001) changes in lumbar-spine BMD were significantly higher in the SG than in the PG. Compared to baseline, BMD significantly increased in both groups at the lumbar spine (p < 0.001 and p = 0.001, respectively) and femoral neck (both p < 0.001), whereas radius BMD only changed significantly in the SG. However, the proportion of patients with osteoporosis/osteopenia significantly declined only at the lumbar spine in the SG (from 69.0 to 37.9%; p = 0.034), whereas no decrease was found in the PG. No severe adverse events occurred.ConclusionsPostoperative anti-osteoporotic treatment can positively influence regain of BMD mainly in the lumbar spine and should be considered. Without treatment, most patients and especially those with low preoperative markers of bone turnover remained osteoporotic/osteopenic 1 year after surgery.
Highlights
Primary hyperparathyroidism affects bone metabolism by advancing turnover through increase in both bone formation and resorption, resulting in a net decrease in bone mineral density (BMD) and strength [1, 2]
Patient withdrawals were due to medical reasons (SG: 2; Placebo group (PG): 3), protocol violations (PG: 2), and nonmedical reasons (SG: 1; PG: 2)
29 patients in the Strontium group (SG) and 23 in the PG were included in the statistical analysis
Summary
Primary hyperparathyroidism (pHPT) affects bone metabolism by advancing turnover through increase in both bone formation and resorption, resulting in a net decrease in bone mineral density (BMD) and strength [1, 2]. The incidence of osteopenia or osteoporosis in patients with pHPT has been estimated at 39% to 59%, affecting BMD at all sites measured (lumbar spine, femur, and radius) [3,4,5]. The fracture risk, especially in vertebral spine, is increased up to fivefold [6,7,8] and is associated with low BMD [9]. PTX resulted in a minor but significant increase in BMD of 0.5% to 4% after 1 year [11, 12] and a 3.3% increase only at the lumbar spine after 5 years [13] in patients with mild disease. No investigations have so far focused on patients with pHPT and preoperatively diagnosed osteoporosis or osteopenia, who generally are at an advanced risk of fractures, especially not for their postoperative change in BMD and bone turnover
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