Prediction of bone mass changes after successful parathyroidectomy using biochemical markers of bone metabolism in primary hyperparathyroidism: is it clinically useful?

Monique Nakayama Ohe,Murilo Catafesta Das Neves,Marise Lazaretti Castro,Rodrigo Oliveira Santos,Livia Marcela Santos,Ilda Sizue Kunii,José Gilberto Henriques Vieira,Marcello Rosano,Teresa Cristina Piscitelli Bonanséa

doi:10.20945/2359-3997000000154

Monique Nakayama Ohe, Murilo Catafesta Das Neves + Show 7 more

Open Access

https://doi.org/10.20945/2359-3997000000154

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Abstract

To measure type 1 serum amino-terminal propeptide procollagen (P1NP) and type 1 cross-linked C-terminal telopeptide collagen (CTX) before parathyroidectomy (PTX) in PHPT patients, correlating these measurements with bone mineral density (BMD) changes. 31 primary hyperparathyroidism (HPTP) were followed from diagnosis up to 12-18 months after surgery. Serum levels of calcium, parathyroid hormone (PTH) vitamin D, CTX, P1NP, and BMD were measured before and 1 year after surgery. One year after PTX, the mean BMD increased by 8.6%, 5.5%, 5.5%, and 2.2% in the lumbar spine, femoral neck (FN), total hip (TH), and distal third of the nondominant radius (R33%), respectively. There was a significant correlation between BMD change 1 year after the PTX and CTX (L1-L4: r = 0.614, p < 0.0003; FN: r = 0.497, p < 0.0051; TH: r = 0.595, p < 0.0005; R33%: r = 0.364, p < 0.043) and P1NP (L1-L4: r = 0,687, p < 0,0001; FN: r = 0,533, p < 0,0024; TH: r = 0,642, p < 0,0001; R33%: r = 0,467, p < 0,0079) preoperative levels. The increase in 25(OH)D levels has no correlation with BMD increase (r = -0.135; p = 0.4816). On linear regression, a minimum preoperative CTX value of 0.331 ng/mL or P1NP of 37.9 ng/mL was associated with a minimum 4% increase in L1-L4 BMD. In TH, minimum preoperative values of 0.684 ng/mL for CTX and 76.0 ng/mL for P1NP were associated with a ≥ 4% increase in BMD. PHPT patients presented a significant correlation between preoperative levels of turnover markers and BMD improvement 1 year after PTX.

Highlights

Primary hyperparathyroidism (PHPT) is a common hypercalcemic disorder caused by abnormally increased secretion of parathyroid hormone (PTH) by one or more parathyroid glands
Even in some developing countries including Brazil, changes in clinical and laboratory findings at the time of diagnosis have been observed over the years, from a very symptomatic condition to an oligosymptomatic and even asymptomatic presentation [12]
Overt symptoms are uncommon, PHPT patients still demonstrate involvement of target organs, including nephrolithiasis and skeletal involvement detected by dual-energy X-ray absorptiometry (DXA) [11]

Summary

Introduction

Primary hyperparathyroidism (PHPT) is a common hypercalcemic disorder caused by abnormally increased secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The hallmark of this condition is the presence of high serum calcium levels and high or inappropriate PTH levels. Radiographic signs of PHPT include skull demineralization in a salt-and-pepper pattern, distal clavicle tapering, subperiosteal bone resorption, and development of cysts and brown tumors. These features combined are described as osteitis fibrosa cystica and are rarely seen in developed countries where more subtle forms of skeletal involvement are observed [3]. High-resolution peripheral quantitative computed tomography (HRpQCT) analysis has shown improvement in bone microarchitecture, cortical thickness, density, and estimated strength following PTX in female PHPT patients [8]

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