Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
Division of Endocrinology and Metabolism, Seoul National University Hospital, Seoul, 03080, Korea.
J Bone Miner Metab. 2022 Mar;40(2):292-300. doi: 10.1007/s00774-021-01279-2. Epub 2021 Nov 10.
Bone loss caused by primary hyperparathyroidism (PHPT) is an indication for parathyroidectomy (PTX). However, whether adding bisphosphonates would be superior to PTX alone to increase bone mass remains unclear. We thus aimed to compare the skeletal effects of the combination treatment of bisphosphonates and PTX with PTX alone.
In this retrospective analysis, bone mineral density (BMD) changes after 1 year of combination treatment and PTX alone were compared. We also analyzed the correlation between changes in serum biochemical parameters and BMD after 1 year of treatment in both groups.
The baseline characteristics of patients treated with PTX alone (n = 24) and combination treatment (n = 26) were comparable. BMD significantly increased after 1 year of treatment in both groups (all p < 0.001), and the increase in BMD at the femur neck was higher in the PTX alone group than in the combination group (p = 0.011). There was a decreasing trend in serum alkaline phosphatase (ALP) levels in PTX alone compared to the combination treatment group (p = 0.053). In the study cohort, lower BMD and higher ALP levels at baseline were associated with higher 1-year BMD changes at all sites. Interestingly, a significant association was found between changes in ALP and BMD at the femur neck in the PTX alone group (p = 0.003), but abolished in the combination group (p = 0.946).
There is no additional benefit of BMD in combination treatment with bisphosphonates and PTX over PTX alone in osteoporotic patients with PHPT. Combined bisphosphonate treatment might interfere with the increase in bone mass caused by PTX.
原发性甲状旁腺功能亢进症（PHPT）引起的骨丢失是甲状旁腺切除术（PTX）的指征。然而，添加双膦酸盐是否优于单独 PTX 来增加骨量尚不清楚。因此，我们旨在比较双膦酸盐联合 PTX 与单独 PTX 的骨骼作用。
在这项回顾性分析中，比较了联合治疗和单独 PTX 治疗 1 年后骨密度（BMD）的变化。我们还分析了两组治疗 1 年后血清生化参数变化与 BMD 的相关性。
单独接受 PTX 治疗（n=24）和联合治疗（n=26）患者的基线特征相当。两组治疗后 1 年 BMD 均显著增加（均 p<0.001），单独 PTX 组股骨颈 BMD 增加高于联合组（p=0.011）。与联合治疗组相比，单独 PTX 组血清碱性磷酸酶（ALP）水平呈下降趋势（p=0.053）。在研究队列中，基线时较低的 BMD 和较高的 ALP 水平与所有部位 1 年 BMD 的变化较高相关。有趣的是，单独 PTX 组中 ALP 和股骨颈 BMD 的变化之间存在显著相关性（p=0.003），但在联合组中这种相关性消失（p=0.946）。
在 PHPT 骨质疏松症患者中，双膦酸盐联合 PTX 治疗与单独 PTX 治疗相比，BMD 没有额外获益。联合双膦酸盐治疗可能会干扰 PTX 引起的骨量增加。
