Ramos Laura, Piedra María, Muñoz Pedro, Vázquez Luis Alberto, García-Unzueta María Teresa, Montalbán Coral, Amado José Antonio
Servicio de Endocrinología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, , Santander (Cantabria), España.
Servicio de Endocrinología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, , Santander (Cantabria), España.
Endocrinol Diabetes Nutr (Engl Ed). 2019 Jan;66(1):41-48. doi: 10.1016/j.endinu.2018.05.010. Epub 2018 Jul 6.
The need for parathyroidectomy to treat asymptomatic patients with primary hyperparathyroidism is controversial. The aim of this study was to assess the impact of parathyroidectomy vs. surveillance on skeletal outcomes such as bone mineral density (BMD) and incident fractures.
This was a retrospective cohort study including 170 patients (112 treated with surgery and 58 subject to active surveillance) between 1991 and 2014. Changes in BMD in lumbar spine, femoral neck, total hip, and radius, and incidence of fractures, were monitored for 2-6 years.
Patients treated with surgery had BMD gains at 2years of 4.37%, as compared to 1.59% in non-operated patients (p<0.05) in the lumbar spine, 3.90% vs. 0.19% (p<0.05) in the femoral neck, and 2.70% vs. 0.14% (p<0.05) in total hip. Gain in BMD in the lumbar spine and femoral neck remained significant in operated patients at 4 and 6 years. No improvement was seen in the radius in operated patients. No significant difference was seen in fracture occurrence between operated and non-operated patients.
Patients with primary hyperparathyroidism treated with surgery experience greater BMD gains than non-operated patients, especially in the lumbar spine and femoral neck. The risk of fracture does not decrease in the group of operated patients.
对于原发性甲状旁腺功能亢进症无症状患者是否需要进行甲状旁腺切除术存在争议。本研究的目的是评估甲状旁腺切除术与观察等待对骨骼结局（如骨矿物质密度（BMD）和骨折发生率）的影响。
这是一项回顾性队列研究，纳入了1991年至2014年间的170例患者（112例接受手术治疗，58例接受积极观察等待）。对腰椎、股骨颈、全髋和桡骨的骨密度变化以及骨折发生率进行了2至6年的监测。
接受手术治疗的患者在2年时腰椎骨密度增加4.37%，未手术患者为1.59%（p<0.05）；股骨颈骨密度增加3.90%，未手术患者为0.19%（p<0.05）；全髋骨密度增加2.70%，未手术患者为0.14%（p<0.05）。手术患者在4年和6年时腰椎和股骨颈的骨密度仍有显著增加。手术患者的桡骨骨密度无改善。手术患者和未手术患者的骨折发生率无显著差异。
接受手术治疗的原发性甲状旁腺功能亢进症患者的骨密度增加幅度大于未手术患者，尤其是在腰椎和股骨颈。手术患者组的骨折风险并未降低。
