Department of Endocrinology and Metabolism (MEA), Aarhus Sygehus, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
Calcif Tissue Int. 2010 Nov;87(5):406-13. doi: 10.1007/s00223-010-9416-6. Epub 2010 Sep 23.
In healthy subjects, smoking is associated with lower plasma levels of parathyroid hormone (PTH) and decreased bone mineral density (BMD). The effect of smoking on PTH, skeletal metabolism, and size/histology of the parathyroid glands in primary hyperparathyroidism (PHPT) is unknown. We investigated, in a cross-sectional study, whether smoking affects PTH levels, BMD, and weight/histology of removed parathyroid tissue in PHPT. We studied 344 (285 women) parathyroidectomized patients with PHPT (24% smokers). Biochemistry was determined at the time of diagnosis. BMD was measured before and after surgical cure. Smoking was associated with lower PTH (9.9 ± 1.8 [SD] vs. 12.2 ± 1.8 pmol/l, P < 0.01) and higher phosphate (0.95 ± 0.17 vs. 0.86 ± 0.17 mmol/l, P < 0.01) levels. Adjustments for between-group differences in age, sex, body weight, plasma creatinine, and 25-hydroxyvitamin D (25OHD) levels did not change the findings. Neither weight of removed adenomatous and hyperplastic tissue nor BMD differed according to smoking status. After adjustment for body weight, age, sex, and 25OHD levels, smokers had slightly lower BMD at the whole body but not at the spine, hip, or forearm. Independent of smoking status, surgical cure caused a significant increase in BMD at all measurement sites. In PHPT smoking is associated with lower plasma PTH and higher phosphate levels. Adjustment for confounders of PTH did not change the results. In contrast to healthy subjects, smoking seems not to decrease BMD in PHPT. Smoking may compromise the correct diagnostic evaluation of borderline hyperparathyroidism. It is unknown to what extent smoking in PHPT affects fracture risk and indication for surgery.
在健康人群中，吸烟与较低的甲状旁腺激素（PTH）水平和骨密度（BMD）降低有关。吸烟对原发性甲状旁腺功能亢进症（PHPT）患者的 PTH、骨骼代谢和甲状旁腺大小/组织学的影响尚不清楚。我们在一项横断面研究中调查了吸烟是否会影响 PHPT 患者的 PTH 水平、BMD 和切除的甲状旁腺组织的重量/组织学。我们研究了 344 例（285 名女性）接受甲状旁腺切除术的 PHPT 患者（24%的吸烟者）。在诊断时测定了生化指标。在手术治愈前后测量了 BMD。吸烟与较低的 PTH（9.9 ± 1.8 [SD] 与 12.2 ± 1.8 pmol/l，P < 0.01）和较高的磷酸盐（0.95 ± 0.17 与 0.86 ± 0.17 mmol/l，P < 0.01）水平相关。调整组间年龄、性别、体重、血浆肌酐和 25-羟维生素 D（25OHD）水平的差异并未改变这些发现。根据吸烟状态，切除的腺瘤性和增生性组织的重量或 BMD 无差异。在调整体重、年龄、性别和 25OHD 水平后，吸烟者全身的 BMD 略低，但脊柱、髋部或前臂的 BMD 无差异。无论吸烟状况如何，手术治愈都会导致所有测量部位的 BMD 显著增加。在 PHPT 中，吸烟与较低的血浆 PTH 和较高的磷酸盐水平相关。调整 PTH 的混杂因素并未改变结果。与健康人群不同，吸烟似乎不会降低 PHPT 患者的 BMD。吸烟可能会影响对边缘性甲状旁腺功能亢进症的正确诊断评估。尚不清楚 PHPT 中的吸烟在多大程度上影响骨折风险和手术指征。
