Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Clin Endocrinol (Oxf). 2020 Jul;93(1):28-35. doi: 10.1111/cen.14195. Epub 2020 May 8.
Primary hyperparathyroidism (PHPT) results in reduction of bone mineral density (BMD) and an increased risk of pathological fractures. Curative surgery does improve BMD; however, the magnitude of rise and predictive factors are highly variable amongst the hitherto available studies.
To quantify the magnitude of improvement in BMD after curative surgery in patients with symptomatic PHPT and dissect out the possible clinical and biochemical parameters predicting the BMD rise.
We conducted a retrospective study of symptomatic PHPT patients undergoing surgery between August 2016 and July 2018. Patients achieving biochemical cure with pre- and post-operative (at least 1 year after surgery) dual-energy X-ray absorptiometry scans performed were included in the study.
After exclusion, 63 patients were included in the study (M:F = 2:5; mean age = 44.8 years). At a median interval of 15 months, the median per cent change in BMD (ΔBMD) at lumbar spine (LS), total hip (TH), femoral neck (FN) and one-third distal radius (forearm) was 6.5%, 7.0%, 8.1% and 6.9%, respectively. Following multiple linear regression analysis, baseline BMD was found to inversely predict ΔBMD at LS, TH and forearm. Pre-operative iPTH positively predicted ΔBMD at LS and FN. Interestingly, 82.5% of the patients had a gain in body weight following curative surgery and change in body weight emerged as a significant positive predictor of ΔBMD at all sites.
Curative surgery improves BMD at all sites in patients with symptomatic PHPT. Weight gain following surgery can be used as a positive clinical predictor of BMD rise.
原发性甲状旁腺功能亢进症（PHPT）会导致骨密度（BMD）降低，增加病理性骨折的风险。根治性手术确实可以改善 BMD；然而，迄今为止的研究中，BMD 升高的幅度和预测因素差异很大。
量化有症状的 PHPT 患者经根治性手术后 BMD 的改善幅度，并找出可能预测 BMD 升高的临床和生化参数。
我们对 2016 年 8 月至 2018 年 7 月期间接受手术的有症状 PHPT 患者进行了回顾性研究。纳入研究的患者需满足以下条件：术前和术后（术后至少 1 年）进行双能 X 线吸收法（DXA）扫描，且生化治愈。
排除后，共有 63 例患者纳入研究（男：女=2:5；平均年龄 44.8 岁）。在中位数为 15 个月的随访期内，腰椎（LS）、全髋（TH）、股骨颈（FN）和三分之一远段桡骨（前臂）的 BMD 百分比变化中位数（ΔBMD）分别为 6.5%、7.0%、8.1%和 6.9%。经多元线性回归分析，基线 BMD 与 LS、TH 和前臂的 ΔBMD 呈负相关。术前甲状旁腺激素（iPTH）与 LS 和 FN 的 ΔBMD 呈正相关。有趣的是，82.5%的患者在根治性手术后体重增加，体重变化成为所有部位 ΔBMD 的显著正预测因素。
根治性手术可改善有症状 PHPT 患者的所有部位的 BMD。术后体重增加可用作 BMD 升高的积极临床预测因素。
