Cipriani Cristiana, Abraham Alice, Silva Barbara C, Cusano Natalie E, Rubin Mishaela R, McMahon Donald J, Zhang Chengchen, Hans Didier, Silverberg Shonni J, Bilezikian John P
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.
Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy.
Endocrine. 2017 Feb;55(2):591-598. doi: 10.1007/s12020-016-1101-8. Epub 2016 Oct 18.
Restoration of the euparathyroid state is associated with improvement of bone dynamics both in hypoparathyroidism and primary hyperparathyroidism. To date, no study has directly compared these two groups following correction of parathyroid hormone excess or deficiency. The study was designed to investigate changes in bone mineral density and trabecular bone score with restoration of the euparathyroid state by parathyroidectomy in primary hyperparathyroidism or recombinant parathyroid hormone [rhPTH(1-84)] replacement in hypoparathyroidism. This was a 2-year prospective intervention study in which we evaluated areal bone mineral density by DXA and trabecular bone score in 52 hypoparathyroid patients on rhPTH(1-84) replacement and 27 patients with primary hyperparathyroidism who underwent parathyroidectomy. We evaluated changes in areal bone mineral density by DXA and trabecular bone score at baseline, 6, 12, 18, and 24 months. After parathyroidectomy, areal bone mineral density increased from baseline at the lumbar spine and total hip at 6 months and at the femoral neck at 12 months, while there were no changes at the distal 1/3 radius. Treatment with rhPTH(1-84) was associated with significant increases in lumbar spine and decreases in distal 1/3 radius areal bone mineral density by 18 months in hypoparathyroid patients. At this time point, hypoparathyroid subjects demonstrated a significant increase in trabecular bone score from baseline, while there were no significant changes in trabecular bone score following parathyroidectomy. Bone mineral density increases both with administration of parathyroid hormone in a state of parathyroid hormone deficiency or removal of parathyroid hormone in a state of parathyroid hormone excess. However, only hypoparathyroid patients on rhPTH(1-84) appeared to have improvements in micro-architectural pattern as assessed by trabecular bone score.
在甲状旁腺功能减退症和原发性甲状旁腺功能亢进症中，恢复正常甲状旁腺状态均与骨动力学改善相关。迄今为止，尚无研究在纠正甲状旁腺激素过多或不足后直接比较这两组情况。本研究旨在通过甲状旁腺切除术恢复原发性甲状旁腺功能亢进症患者的正常甲状旁腺状态，或通过重组甲状旁腺激素[rhPTH(1-84)]替代治疗甲状旁腺功能减退症，来研究骨矿物质密度和小梁骨评分的变化。这是一项为期2年的前瞻性干预研究，我们通过双能X线吸收法（DXA）评估了52例接受rhPTH(1-84)替代治疗的甲状旁腺功能减退症患者以及27例接受甲状旁腺切除术的原发性甲状旁腺功能亢进症患者的面积骨矿物质密度和小梁骨评分。我们在基线、6个月、12个月、18个月和24个月时评估了DXA测量的面积骨矿物质密度和小梁骨评分的变化。甲状旁腺切除术后，腰椎和全髋部的面积骨矿物质密度在6个月时较基线增加，股骨颈在12个月时较基线增加，而桡骨远端1/3处无变化。在甲状旁腺功能减退症患者中，rhPTH(1-84)治疗18个月后，腰椎面积骨矿物质密度显著增加，桡骨远端1/3处面积骨矿物质密度降低。此时，甲状旁腺功能减退症患者的小梁骨评分较基线显著增加，而甲状旁腺切除术后小梁骨评分无显著变化。在甲状旁腺激素缺乏状态下给予甲状旁腺激素或在甲状旁腺激素过多状态下切除甲状旁腺激素均会使骨矿物质密度增加。然而，仅接受rhPTH(1-84)治疗的甲状旁腺功能减退症患者在通过小梁骨评分评估的微观结构模式上似乎有改善。
