Giocondo Margot, Ponte Belén, de Seigneux Sophie, Sadowski Samira M, Bédat Benoît, Triponez Frédéric, Demarchi Marco Stefano
Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Nephrology and Hypertension Division, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Front Endocrinol (Lausanne). 2025 May 28;16:1562340. doi: 10.3389/fendo.2025.1562340. eCollection 2025.
Primary hyperparathyroidism (PHPT) is a condition recognized to include distinct biochemical phenotypes: hypercalcemic, normocalcemic, and normohormonal PHPT. This condition is characterized by inappropriately elevated parathyroid hormone (PTH) levels relative to serum calcium levels, leading to high bone turnover and decreased bone mineral density (BMD). Although BMD has been shown to improve following curative parathyroidectomy (PTX), there is limited data on the relationship between BMD changes after PTX and according to the clinical phenotypes of PHPT. This prospective study aims to identify the best candidates for surgery among these three phenotypes of PHPT by examining symptoms and comorbidities, biochemical results, and both pre- and post-operative DXA scans.
This is a prospective single-center study including 104 consecutive patients who underwent PTX for PHPT. Sociodemographic profiles and biochemical results were collected at both pre- and at 6 months post-surgery. All patients underwent dual-energy x-ray absorptiometry (DXA) scans at 1 and 6 months before surgery, and again between 12 and 18 months after surgery, to assess and compare changes in bone mineral density (BMD). Patients were categorized into three subgroups (normohormonal, hyperparathyroid normocalcemic and hyperparathyroid hypercalcemic) to assess differences in BMD improvement across these groups.
According to predefined thresholds, 40.0% of patients experienced a significant BMD gain at the spine, 35.1% at the femur, 23.5% at the left hip, and 8.6% at the radius. Additionally, a greater postoperative drop in PTH was associated with larger BMD gains at the spine (SD 0.07; mean 0.03) and left femur bone (SD 0.06; mean 0.02). There was no significant change in T-score at the one-third radius. Higher preoperative urinary calcium level was associated with greater BMD and T-score improvement at the left hip. All PHPT phenotypes demonstrated similar postoperative BMD gains. No differences in BMD improvement were observed between males and females, nor was there any correlation between BMD gains and age.
Our findings suggest that BMD improves in all PHPT patients undergoing curative PTX, irrespective of clinical phenotype, age or sex. While patients with more severe biochemical profiles exhibited greater increases in BMD and T-scores, milder forms showed favorable trends that require confirmation in larger studies.
原发性甲状旁腺功能亢进症（PHPT）是一种被认为包括不同生化表型的疾病：高钙血症型、血钙正常型和激素水平正常型PHPT。这种疾病的特征是甲状旁腺激素（PTH）水平相对于血清钙水平不适当升高，导致高骨转换和骨矿物质密度（BMD）降低。尽管已证明根治性甲状旁腺切除术（PTX）后BMD有所改善，但关于PTX后BMD变化与PHPT临床表型之间关系的数据有限。这项前瞻性研究旨在通过检查症状和合并症、生化结果以及术前和术后的双能X线吸收测定（DXA）扫描，确定这三种PHPT表型中最适合手术的患者。
这是一项前瞻性单中心研究，纳入了104例连续接受PTX治疗PHPT的患者。在术前和术后6个月收集社会人口统计学资料和生化结果。所有患者在手术前1个月和6个月以及手术后12至18个月之间接受双能X线吸收测定（DXA）扫描，以评估和比较骨矿物质密度（BMD）的变化。患者被分为三个亚组（激素水平正常型、甲状旁腺功能亢进血钙正常型和甲状旁腺功能亢进高钙血症型），以评估这些组之间BMD改善的差异。
根据预定义的阈值，40.0%的患者脊柱BMD显著增加，股骨为35.1%，左髋为23.5%，桡骨为8.6%。此外，术后PTH下降幅度越大，脊柱（标准差0.07；平均值0.03）和左股骨（标准差0.06；平均值0.02）的BMD增加越大。桡骨三分之一处的T值无显著变化。术前尿钙水平越高，左髋的BMD和T值改善越大。所有PHPT表型术后BMD增加相似。男性和女性之间在BMD改善方面未观察到差异，BMD增加与年龄之间也无相关性。
我们的研究结果表明，所有接受根治性PTX的PHPT患者，无论临床表型、年龄或性别如何，BMD均有所改善。虽然生化指标较严重的患者BMD和T值增加幅度更大，但较轻的形式显示出良好的趋势，需要在更大规模的研究中得到证实。
