Lumachi Franco, Camozzi Valentina, Ermani Mario, DE Lotto Federica, Luisetto Giovanni
Endocrinesurgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
Ann N Y Acad Sci. 2007 Nov;1117:357-61. doi: 10.1196/annals.1402.012. Epub 2007 Jul 23.
The aim of this study was to evaluate the short-term (1 year) changes of the lumbar spine (L2-L4) bone mineral density (LS-BMD) after parathyroidectomy (PTx) in pre- and postmenopausal women with primary hyperparathyroidism (PHPT). A series of 48 women (median age 56 years, range 23-82 years) with confirmed PHPT were prospectively enrolled in the study. Patients who received both oral contraceptives less than 2 years before the diagnosis and estrogen replacement therapy have previously been excluded. All patients underwent LS-BMD by dual energy x-ray absorptiometry before surgery. Patients were divided into two groups: group A (n = 12) premenopausal, and group B (n = 36) postmenopausal patients. The LS-BMD was repeated 12 months after successful PTx. Basal LS-BMD (0.852 +/- 0.061 vs. 0.748 +/- 0.142 g/cm(2)), serum calcium (2.95 +/- 0.23 vs. 2.94 +/- 0.26 mmol/L), creatinine (69.2 +/- 17.5 vs. 82.0 +/- 24.2 micromol/L), alkaline phosphatase (107.4 +/- 43.6 vs. 151.3 +/- 95.7 U/L), osteocalcin (28.6 +/- 9.3 vs. 28.2 +/- 8.3 microg/L), and PTH (192.7 +/- 133.2 vs. 175.2 +/- 132.1 ng/L) levels did not differ significantly (P = NS) between groups. The 1-year LS-BMD was 0.921 +/- 0.048 and 0.825 +/- 0.151 g/cm(2) in group A and B, respectively. In group B patients, the 1-year LS-BMD value did not improve significantly (P = NS), while in group A patients the difference between basal and postsurgical LS-BMD was significant (P < 0.01). In conclusion, PTx should be considered for all patients with PHPT and loss of bone density, but in premenopausal patients a greatest improvement of BMD may be found, suggesting the need of endogenous estrogens in complete lumbar bone recovery after surgery.
本研究旨在评估原发性甲状旁腺功能亢进症（PHPT）的绝经前和绝经后女性甲状旁腺切除术后（PTx）腰椎（L2-L4）骨密度（LS-BMD）的短期（1年）变化。48例确诊为PHPT的女性（中位年龄56岁，范围23-82岁）前瞻性纳入本研究。排除诊断前2年内服用口服避孕药及曾接受雌激素替代治疗的患者。所有患者术前均采用双能X线吸收法测定LS-BMD。患者分为两组：A组（n = 12）为绝经前患者，B组（n = 36）为绝经后患者。PTx成功后12个月重复测定LS-BMD。两组患者的基础LS-BMD（0.852±0.061 vs. 0.748±0.142 g/cm²）、血清钙（2.95±0.23 vs. 2.94±0.26 mmol/L）、肌酐（69.2±17.5 vs. 82.0±24.2 μmol/L）、碱性磷酸酶（107.4±43.6 vs. 151.3±95.7 U/L）、骨钙素（28.6±9.3 vs. 28.2±8.3 μg/L）和甲状旁腺激素（PTH）（192.7±133.2 vs. 175.2±132.1 ng/L）水平差异无统计学意义（P = NS）。A组和B组1年时的LS-BMD分别为0.921±0.048和0.825±0.151 g/cm²。B组患者1年时的LS-BMD值无显著改善（P = NS），而A组患者基础LS-BMD与术后LS-BMD的差异有统计学意义（P < 0.01）。总之，对于所有患有PHPT且骨密度降低的患者均应考虑PTx，但绝经前患者可能骨密度改善最大，提示术后腰椎骨完全恢复需要内源性雌激素。
