Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, New York.
Department of Medicine, University Center of Belo Horizonte, Belo Horizonte, Brazil.
J Clin Endocrinol Metab. 2018 Jan 1;103(1):196-205. doi: 10.1210/jc.2017-01932.
High-resolution peripheral quantitative computed tomography (HRpQCT) is a noninvasive imaging technology that can provide insight into skeletal microstructure and strength. In asymptomatic primary hyperparathyroidism (PHPT), HRpQCT imaging has demonstrated both decreased cortical and trabecular indices, consistent with evidence for increased fracture risk. There are limited data regarding changes in HRpQCT parameters postparathyroidectomy.
To evaluate changes in skeletal microstructure by HRpQCT in subjects with PHPT after parathyroidectomy.
We studied 29 subjects with PHPT (21 women, 8 men) with HRpQCT at baseline and 6, 12, 18, and 24 months postparathyroidectomy.
Volumetric bone mineral density, microarchitectural indices, and finite element analysis at the distal radius and tibia.
At both the radius and tibia, there were significant improvements in total, cortical, and trabecular volumetric bone density as early as 6 months postparathyroidectomy (24-month values for total volumetric bone density, radius: +2.8 ± 4%, tibia: +4.4 ± 4%; P < 0.0001 for both), cortical thickness (radius: +1.1 ± 2%, tibia: +2.0 ± 3%; P < 0.01 for both), and trabecular bone volume (radius: +3.8 ± 5%, tibia: +3.2 ± 4%; P < 0.0001 for both). At both sites, by finite element analysis, stiffness and failure load were improved starting at 6 months postparathyroidectomy (24-month values for failure load, radius: +6.2 ± 6%, tibia: +4.8 ± 7%; P < 0.0001 for both).
These results provide information about skeletal microarchitecture in subjects with PHPT followed through 2 years after parathyroidectomy. Estimated bone strength is improved, consistent with data showing decreased fracture risk postparathyroidectomy.
高分辨率外周定量计算机断层扫描（HRpQCT）是一种非侵入性成像技术，可深入了解骨骼微结构和强度。在无症状原发性甲状旁腺功能亢进症（PHPT）中，HRpQCT 成像显示皮质和小梁指数均降低，这与骨折风险增加的证据一致。关于甲状旁腺切除术后 HRpQCT 参数变化的数据有限。
评估甲状旁腺切除术后 PHPT 患者骨骼微结构的变化。
我们研究了 29 例 PHPT 患者（21 名女性，8 名男性），他们在基线和甲状旁腺切除术后 6、12、18 和 24 个月时进行 HRpQCT 检查。
桡骨和胫骨的体积骨密度、微结构指数和有限元分析。
在桡骨和胫骨中，早在甲状旁腺切除术后 6 个月，总骨密度、皮质骨密度和小梁骨密度就有显著改善（桡骨总骨密度 24 个月值：+2.8%±4%，胫骨：+4.4%±4%；两者均 P<0.0001）、皮质厚度（桡骨：+1.1%±2%，胫骨：+2.0%±3%；两者均 P<0.01）和小梁骨体积（桡骨：+3.8%±5%，胫骨：+3.2%±4%；两者均 P<0.0001）。在两个部位，通过有限元分析，刚度和失效负荷从甲状旁腺切除术后 6 个月开始改善（桡骨失效负荷 24 个月值：+6.2%±6%，胫骨：+4.8%±7%；两者均 P<0.0001）。
这些结果提供了 PHPT 患者在甲状旁腺切除术后 2 年内骨骼微结构的信息。估计骨强度得到改善，与甲状旁腺切除术后骨折风险降低的数据一致。
