Lumachi Franco, Camozzi Valentina, Ermani Mario, Nardi Alfredo, Luisetto Giovanni
Endocrinesurgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, 35128 Padova, Italy.
Ann N Y Acad Sci. 2007 Nov;1117:362-6. doi: 10.1196/annals.1402.031. Epub 2007 Jul 26.
Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone (PTH), and catabolic and anabolic effects of PTH on bone may lead to overall deleterious effects on skeleton. The aim of this study was to analyze the changes in lumbar spine bone mineral density (BMD) in patients with PHPT who underwent parathyroidectomy (PTx), and to correlate the main demographics and biochemical parameters with pre- and postoperative BMD values. Two groups of age-matched patients (group A = 14 postmenopausal women; group B = 13 men, overall median age 53 years, range 26-56 years) with confirmed PHPT were enrolled in the study. All patients underwent lumbar (L2-L4 region) spine osteodensitometry using a dual-energy X-ray absorptiometry (DXA) prior to surgery. A significant correlation between alkaline phosphatase (ALP) and PTH (R = 0.73, P = 0.003) was found in group A patients. In group B correlations were found between calcemia and ALP (R = 0.71, P = 0.007), and between osteocalcin and both PTH (R = 0.65, P = 0.01) and ALP (R = 0.59, P = 0.03). No correlation (P = NS) was found between BMD, both basal and postoperative, and age or biochemical parameters. The 1-year BMD were 0.937 +/- 0.115 and 0.940 +/- 0.201 g/cm(2) (P = NS) in group A and B, respectively. A significant (P = 0.03) difference between basal and 1-year BMD was found only in group A, while in group B the difference was not significant. In conclusion, in patients with PHPT bone turnover is increased and consequently the BMD is reduced, but unfortunately PTx does not allow for complete bone restoring. However, in premenopausal women the BMD values of the lumbar spine significantly improve after PTx, suggesting a higher bone sensitivity to serum PTH normalization due to a synergic action with estrogens.
原发性甲状旁腺功能亢进症（PHPT）是由甲状旁腺激素（PTH）分泌过多引起的，PTH对骨骼的分解代谢和合成代谢作用可能会对骨骼产生整体有害影响。本研究的目的是分析接受甲状旁腺切除术（PTx）的PHPT患者腰椎骨密度（BMD）的变化，并将主要人口统计学和生化参数与术前和术后BMD值进行关联。两组年龄匹配的确诊PHPT患者（A组 = 14名绝经后女性；B组 = 13名男性，总体中位年龄53岁，范围26 - 56岁）纳入本研究。所有患者在手术前使用双能X线吸收法（DXA）进行腰椎（L2 - L4区域）骨密度测定。在A组患者中发现碱性磷酸酶（ALP）与PTH之间存在显著相关性（R = 0.73，P = 0.003）。在B组中，发现血钙与ALP之间存在相关性（R = 0.71，P = 0.007），骨钙素与PTH（R = 0.65，P = 0.01）和ALP（R = 0.59，P = 0.03）之间均存在相关性。未发现基础和术后BMD与年龄或生化参数之间存在相关性（P = 无统计学意义）。A组和B组1年时的BMD分别为0.937±0.115和0.940±0.201 g/cm²（P = 无统计学意义）。仅在A组中发现基础BMD与1年BMD之间存在显著差异（P = 0.03），而在B组中差异不显著。总之，在PHPT患者中骨转换增加，因此BMD降低，但不幸的是PTx并不能使骨骼完全恢复。然而，在绝经前女性中，PTx后腰椎的BMD值显著改善，这表明由于与雌激素的协同作用，骨骼对血清PTH正常化的敏感性更高。
