França Tatiana Clementino Pinto Toscano de, Griz Luiz, Pinho Jorge, Diniz Erik Trovão, Andrade Luena Dias de, Lucena Cynthia Salgado, Beserra Susyane Ribeiro, Asano Nadja Maria Jorge, Duarte Angela Pinto, Bandeira Francisco
Centro de Osteoporose de Pernambuco, Department of Endocrinology, Hospital Agamenon Magalhães/SUS, Universidade de Pernambuco, Recife, PE, Brazil.
Rev Bras Reumatol. 2011 Mar-Apr;51(2):131-7.
To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica.
Review of the medical records of six patients using bisphosphonates preoperatively.
Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm(2) (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm(2) (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm(2) (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33.
The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.
评估双膦酸盐对纤维囊性骨炎患者甲状旁腺切除术后低钙血症的影响。
回顾6例术前使用双膦酸盐患者的病历。
平均年龄为35.6±10.5岁；血清钙=13.51+0.87mg/dL；iPTH=1389+609pg/mL。3例患者尿脱氧吡啶啉（UDPD）的平均值为131±183nmol/mmol Cr，C-末端肽（CTX）为2253±1587pg/mL。骨密度测定（T值）的平均值如下：腰椎（L2-L4）为0.673±0.150g/cm²（-4.42±1.23）；股骨颈为0.456±0.149g/cm²（-5.58±1.79）；桡骨33为0.316±0.055g/cm²（-5.85±0.53）。患者1口服阿仑膦酸钠，30mg/天，共4周；其血钙从14mg/dL降至11.6mg/dL，UDPD从342nmol/mmol Cr降至160nmol/mmol Cr。患者2口服阿仑膦酸钠，20mg/天，共6周；其血钙从14mg/dL降至11.0mg/dL，UDPD从28.8nmol/mmol Cr降至14nmol/mmol Cr。患者3术前静脉注射帕米膦酸钠90mg。患者4口服阿仑膦酸钠，140mg/周，共6周；其血钙从13.7mg/dL降至12.3mg/dL，CTX从2160pg/mL降至1340pg/mL。患者5口服阿仑膦酸钠，140mg/周，共6周；其血钙水平从14.3mg/dL降至14.1mg/dL；CTX未变化。患者6术前10天静脉注射伊班膦酸钠150mg；其CTX降低了62%。术后第一周无患者发生严重低钙血症。术后一年，L2-L4骨密度平均增加40%±29%，股骨颈增加86±39%，桡骨33增加22%±11%。
甲状旁腺切除术后随访中，术前使用双膦酸盐似乎可减轻骨饥饿，同时不影响骨量显著增加。
