Ballem Naveen, Greene Andrew B, Parikh Rikesh T, Berber Eren, Siperstein Allan, Milas Mira
Department of General Surgery, Endocrine Surgery Section, Cleveland Clinic, Cleveland, OH 44195, USA.
Endocr Pract. 2008 Oct;14(7):820-31. doi: 10.4158/EP.14.7.820.
To define the scope of bone disease among men referred for parathyroidectomy and to document bone density screening trends in this high-risk population.
Clinical data were analyzed from a prospectively maintained database of 1000 patients undergoing parathyroidectomy for sporadic primary hyperparathyroidism at the Cleveland Clinic between 2000 and 2006. Information collected included demographics, reason for referral, body mass index, intraoperative findings, preoperative and postoperative laboratory values (serum calcium, phosphorus, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urinary calcium excretion), and preoperative and postoperative dual-energy x-ray absorptiometry (DXA) findings.
Of the 1000 patients, 243 (24%) were men. As with women, bone health-related issues were the most common reason for referral (32%). In 2000, only 12% of men had preoperative DXA scans; this rose to 42% by 2005. The frequency of prereferral DXA screening increased throughout the study, but even by 2006, referring physicians did not screen most of their male patients. In 2000, the prevalence of bone disease (osteoporosis or osteopenia) in men was 8%, but with improved screening, this increased to 26%, approaching the 34% rate in women. Preoperative and postoperative levels of calcium, parathyroid hormone, phosphorus, 24-hour urinary calcium, and 25-hydroxyvitamin D were the same among men with and without bone disease. Analysis of postoperative DXA scans revealed that gains in postparathyroidectomy bone density were significantly greater in men than in women at all anatomic testing sites. In men, lowest T scores improved by a mean +/- SEM of +0.35 +/- 0.09 compared with +0.098 +/- 0.035 in women (P = .009). Men were 4 times less likely than women to have continued bone loss after parathyroidectomy.
Clinical and laboratory parameters cannot identify men with hyperparathyroidism who have bone loss, illustrating the need for routine DXA screening. Despite this, DXA remains underused. Improved screening practices will favorably effect men's health.
明确因甲状旁腺切除术而转诊男性的骨病范围，并记录该高危人群的骨密度筛查趋势。
对克利夫兰诊所2000年至2006年间接受甲状旁腺切除术治疗散发性原发性甲状旁腺功能亢进的1000例患者的前瞻性维护数据库中的临床数据进行分析。收集的信息包括人口统计学资料、转诊原因、体重指数、术中发现、术前和术后实验室检查值（血清钙、磷、甲状旁腺激素、25-羟维生素D和24小时尿钙排泄量）以及术前和术后双能X线吸收法（DXA）检查结果。
1000例患者中，243例（24%）为男性。与女性一样，与骨骼健康相关的问题是最常见的转诊原因（32%）。2000年，只有12%的男性进行了术前DXA扫描；到2005年，这一比例升至42%。在整个研究过程中，转诊前DXA筛查的频率有所增加，但即使到2006年，转诊医生也未对大多数男性患者进行筛查。2000年，男性骨病（骨质疏松或骨质减少）的患病率为8%，但随着筛查的改善，这一比例增至26%，接近女性的34%。有骨病和无骨病男性的术前和术后钙、甲状旁腺激素、磷、24小时尿钙和25-羟维生素D水平相同。对术后DXA扫描的分析显示，甲状旁腺切除术后男性所有解剖检测部位的骨密度增加均显著大于女性。男性中，最低T值平均改善了+0.35±0.09，而女性为+0.098±0.035（P = 0.009）。甲状旁腺切除术后男性骨量持续丢失的可能性比女性低4倍。
临床和实验室参数无法识别甲状旁腺功能亢进且有骨质流失的男性，这表明需要进行常规DXA筛查。尽管如此，DXA的使用仍然不足。改善筛查方法将对男性健康产生有利影响。
