From the (1)Departments of Endocrinology.
Endocrine Surgery.
Endocr Pract. 2020 Dec;26(12):1442-1450. doi: 10.4158/EP-2020-0148.
This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery.
This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery.
Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638±0.093 versus 0.698±0.041 g/cm; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH.
The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline.
25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score.
本前瞻性研究旨在评估印度有症状原发性甲状旁腺功能亢进症（PHPT）患者的小梁骨评分、骨密度（BMD）和骨生化，并研究基线甲状旁腺激素（PTH）对治愈性手术后这些参数恢复的影响。
这是在印度南部一家三级保健中心进行的为期 2 年的前瞻性研究。基线评估包括人口统计学细节、表现模式、骨矿物质生化、BMD、小梁骨评分（TBS）和骨转换标志物（BTMs）。这些参数在治愈性甲状旁腺手术后的第一年和第二年结束时进行重新评估。
本研究纳入了 51 例接受治愈性甲状旁腺切除术的 PHPT 患者（32 名男性和 19 名女性）。平均（SD）年龄为 44.6（13.7）岁。与基线 PTH 较低（<250 pg/mL）的组相比，基线 PTH 较高（≥250 pg/mL）的患者腰椎和前臂的 TBS、BTMs 和 BMD 明显更差。在 2 年结束时，高与低 PTH 组之间（均值±SD）的差异仅在第 2 年的前臂 BMD 中持续存在（0.638±0.093 与 0.698±0.041 g/cm；P =.01）。然而，在治愈性甲状旁腺切除术后第 1 年和第 2 年的随访中，根据基线 PTH 分层，两组之间的股骨颈、腰椎和 TBS 的 BTMs 和 BMD 均无显著差异。
即使在手术后 2 年，高基线 PTH 的个体前臂 BMD 仍明显较差，而其他参数包括 TBS 均从基线显著改善。
25（OH）D = 25-羟维生素 D；BMD = 骨密度；BMI = 体重指数；BTMs = 骨转换标志物；CTX = 1 型胶原 C 端肽；DXA = 双能 X 射线吸收法；P1NP = 1 型前胶原 N 端前肽；PHPT = 原发性甲状旁腺功能亢进症；PTH = 甲状旁腺激素；TBS = 小梁骨评分。
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