Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Endocrinol Metab. 2022 May 17;107(6):e2474-e2480. doi: 10.1210/clinem/dgac083.
Predicting bone mineral density (BMD) gain after parathyroidectomy may influence individualized therapeutic approaches for treating patients with primary hyperparathyroidism (PHPT).
This study aimed to assess whether skeletal muscle mass data could predict BMD change after parathyroidectomy in patients with PHPT.
This retrospective study collected data from 2012 to 2021 at Severance Hospital, Seoul, Korea. A total of 130 patients (mean age, 64.7 years; 81.5% women) with PHPT who underwent parathyroidectomy were analyzed. Thoracic muscle volume (T6-T7 level) was estimated using noncontrast parathyroid single photon emission computed tomography/computed tomography (SPECT/CT) scans and an automated deep-learning-based software. The primary outcome assessed was the change in femoral neck BMD (FNBMD, %) 1 year after parathyroidectomy.
The median degree of FNBMD change after parathyroidectomy was + 2.7% (interquartile range: -0.9 to + 7.6%). Elevated preoperative PTH level was associated with lower thoracic muscle mass (adjusted β: -8.51 cm3 per one log-unit PTH increment, P = .045) after adjusting for age, sex, body mass index (BMI), and baseline FNBMD. One SD decrement in thoracic muscle mass was associated with lesser FNBMD (adjusted β: -2.35%, P = .034) gain and lumbar spine BMD gain (adjusted β: -2.51%, P = .044) post surgery after adjusting for covariates.
Lower thoracic skeletal muscle mass was associated with elevated preoperative PTH levels in patients with PHPT. Lower skeletal muscle mass was associated with lesser BMD gain after parathyroidectomy, independent of age, sex, BMI, preoperative BMD, and PTH level.
甲状旁腺切除术后骨密度（BMD）的增加预测可能会影响治疗原发性甲状旁腺功能亢进症（PHPT）患者的个体化治疗方法。
本研究旨在评估骨骼肌肉质量数据是否可以预测 PHPT 患者甲状旁腺切除术后 BMD 的变化。
本回顾性研究于 2012 年至 2021 年在韩国首尔的 Severance 医院进行。共分析了 130 例接受甲状旁腺切除术的 PHPT 患者（平均年龄 64.7 岁，81.5%为女性）。使用非对比甲状旁腺单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）扫描和基于自动深度学习的软件估计 T6-T7 水平的胸椎肌肉量。主要评估指标是甲状旁腺切除术后 1 年股骨颈 BMD（FNBMD，%）的变化。
甲状旁腺切除术后 FNBMD 变化的中位数为+2.7%（四分位距：-0.9 至+7.6%）。调整年龄、性别、体重指数（BMI）和基线 FNBMD 后，术前甲状旁腺激素（PTH）水平升高与较高的胸椎肌肉量相关（调整后的β：每增加一个对数单位 PTH 增加 8.51 cm3，P=0.045）。调整协变量后，胸椎肌肉质量每减少 1 SD，FNBMD （调整后的β：-2.35%，P=0.034）和腰椎 BMD （调整后的β：-2.51%，P=0.044）的增加量就越小。
PHPT 患者的胸椎骨骼肌质量与术前 PTH 水平升高有关。在调整年龄、性别、BMI、术前 BMD 和 PTH 水平后，骨骼肌肉质量较低与甲状旁腺切除术后 BMD 增加较少有关。
