Bergenfelz A, Lindergård B, Ahrén B
Department of Surgery, Lund University, Sweden.
Ann Chir Gynaecol. 1993;82(4):245-9.
Primary hyperparathyroidism (pHPT) is associated with osteopenia. However, the individual variation in recovery in bone mass after surgery is large. Therefore, modes of prediction of the increase in bone mass after parathyroid surgery were investigated. Preoperatively and at one year after surgery bone mineral content (BMC) in the distal radius was measured with single photon absorptiometry technique in 40 patients with pHPT. Serum levels of calcium, intact parathyroid hormone (PTH), alkaline phosphatase, osteocalcin and Vitamin D metabolites were also determined. Preoperatively, Z-score of BMC was -0.85 +/- 1.20 SD below the normal mean. There was a modest association between BMC and serum levels of osteocalcin (r = -0.34; P < 0.05), and dihydroxycholecalciferol (r = -0.35; P < 0.05). At one year after surgery, mean BMC increased by 2% (P < 0.05), but with a wide dispersion. Preoperative Z-score of BMC correlated with the relative change in BMC (r = -0.33; P < 0.05). An increase in BMC with 95% confidence was evident in 10 of the patients. None of these patients had a preoperative Z-score of BMC above the mean expected for age and sex. We conclude that the increase in bone mass after surgery for pHPT is small and evident only in a portion (approximately 25%) of patients. Hence, a decrease in bone mass should not be a major indication for surgery in pHPT.
原发性甲状旁腺功能亢进症（pHPT）与骨质减少有关。然而，手术后骨量恢复的个体差异很大。因此，对甲状旁腺手术后骨量增加的预测模式进行了研究。采用单光子吸收法技术，对40例pHPT患者术前及术后1年测量桡骨远端的骨矿物质含量（BMC）。还测定了血清钙、完整甲状旁腺激素（PTH）、碱性磷酸酶、骨钙素和维生素D代谢产物的水平。术前，BMC的Z值比正常平均值低0.85±1.20标准差。BMC与血清骨钙素水平（r = -0.34；P < 0.05）和二羟胆钙化醇（r = -0.35；P < 0.05）之间存在适度关联。术后1年，平均BMC增加了2%（P < 0.05），但离散度较大。术前BMC的Z值与BMC的相对变化相关（r = -0.33；P < 0.05）。10例患者的BMC明显增加，且增加幅度有95%的置信区间。这些患者术前BMC的Z值均未高于年龄和性别的预期平均值。我们得出结论，pHPT手术后骨量增加幅度较小，仅在部分（约25%）患者中明显。因此，骨量减少不应成为pHPT手术的主要指征。
