Endocrinology Department, Medical Centre for Postgraduate Education, Bielanski Hospital, Warsaw, Poland.
Adv Med Sci. 2012;57(2):308-13. doi: 10.2478/v10039-012-0062-2.
Accelerated rate of bone turnover and increased resorption due to primary hyperparathyroidism (PHPT) result in osteopenia and an increase in the fracture risk. However, there are no data about the relative frequency of the PHPT in the subpopulation with the low bone mass. The aim of the study was to evaluate the diagnostic power of the bone densitometry in diagnosis of PHPT.
Material consisted of 4016 new patients: 2504 women and 1512 men. Bone mineral density (BMD) in the L2 - L4 vertebra and femoral neck was measured by DEXA (LUNAR - DPX or LUNAR - EXPERT, Lunar Radiation Corp., USA). All the patients with BMD Z-score below -2.0 SD (according to the sex and age) were the subjects of further diagnostic procedures. The serum calcium and intact PTH level as well as 24-hours urine excretion was measured.
In 451 (331 women and 120 men) out of the total 4016 patients, the measured BMD Z-scores were below -2.0 SD. Out of these 451 patients, 52 were diagnosed with PHPT. In 41 patients, diagnosis of PHPT was based on elevated serum intact PTH in the face of overt hypercalcemia. The remaining 11 normocalcemic patients with elevated PTH and coexisting vitamin D deficiency, will become hypercalcemic after vitamin D replacement.
In the large cohort of unselected patients who presented for bone densitometry, a very high (11.5%) prevalence of PHPT was found among subjects with low bone mass (BMD Z-score less than -2.0 SD). Presented results confirm the importance of the BMD measurements in the screening of the disease.
由于原发性甲状旁腺功能亢进症（PHPT）导致骨转换率加速和吸收增加，导致骨量减少和骨折风险增加。然而，对于骨量减少的亚人群，尚无关于 PHPT 的相对频率的数据。本研究旨在评估骨密度测量在 PHPT 诊断中的诊断能力。
研究对象为 4016 名新就诊患者：2504 名女性和 1512 名男性。通过 DEXA（LUNAR-DPX 或 LUNAR-EXPERT，Lunar Radiation Corp.，美国）测量 L2-L4 椎体和股骨颈的骨矿物质密度（BMD）。所有 BMD Z 评分低于-2.0 SD（根据性别和年龄）的患者均接受进一步诊断。测量血清钙和完整 PTH 水平以及 24 小时尿排泄量。
在 4016 名患者中，有 451 名（331 名女性和 120 名男性）患者的测量 BMD Z 评分低于-2.0 SD。在这 451 名患者中，有 52 名被诊断为 PHPT。在 41 名患者中，PHPT 的诊断基于明显高钙血症时血清完整 PTH 升高。其余 11 名血钙正常但 PTH 升高且伴有维生素 D 缺乏的患者，在补充维生素 D 后将出现高钙血症。
在接受骨密度测量的大量未经选择的患者中，骨量减少（BMD Z 评分低于-2.0 SD）患者中 PHPT 的患病率非常高（11.5%）。目前的结果证实了 BMD 测量在疾病筛查中的重要性。
