Diamond T, Ng A T, Levy S, Magarey C, Smart R
Department of Endocrinology, St. George Hospital, Sydney, Australia.
Osteoporos Int. 1996;6(4):329-33. doi: 10.1007/BF01623394.
Parathyroid surgery is indicated in patients presenting with primary hyperparathyroidism (PHPT) and osteoporosis (defined as bone mineral density more than 2 standard deviations below normal). Many are elderly women with complex medical problems, either unwilling or considered unfit for surgery. Estrogen replacement therapy (ERT) may potentially be an alternative form of therapy in this group. We studied 15 consecutive postmenopausal women presenting with PHPT and osteoporosis. Group 1 comprised 5 women who elected to be treated with ERT (conjugated equine estrogen, 0.3-0.625 mg/day). The other 10 women underwent successful parathyroidectomy. These 10 patients were randomly subdivided into group 2 (5 patients who received calcitriol 0.25 micrograms b.i.d. for 12 months following surgery) and group 3 (5 patients who received elemental calcium 1 g/day for 12 months following surgery). Lumbar spine and femoral neck bone mineral density (BMD) were measured prior to and after 12 months of therapy, using a dual-energy X-ray absorptiometer (Lunar DPX-L). The three groups did not differ with respect to their ages (group mean 71.8 years), or baseline serum calcium (group mean 2.77 mmol/l), serum parathyroid hormone (group mean 11.0 pmol/l), lumbar spine BMD (group mean 0.93 g/cm2) and femoral neck BMD (group mean 0.73 g/cm2). Serum calcium normalized in all patients who underwent surgery and none developed hypoparathyroidism. A non-significant decrease in serum calcium was seen in patients treated with ERT only. Lumbar spine (+5.3% per year; 95% CI, 1.1% to 9.6%) and femoral neck BMD (+5.5% per year; 95% CI, -2.1% to 13.2%) increased significantly after 12 months of ERT (p < 0.001 compared with pre-therapy values). These increases in BMD did not differ significantly from those in patients who underwent successful parathyroidectomy followed by either calcitriol therapy or calcium replacement (lumbar spine BMD increase of +6.2% per year, 95% CI 3.1% to 9.4%; and femoral neck BMD increase of +3% per year, 95% CI 0 to 6%). In summary, increases in lumbar spine and femoral neck BMD occur following treatment of PHPT. ERT appeared as effective as parathyroidectomy (combined with either calcitriol or calcium supplements) for the treatment of osteoporosis in elderly postmenopausal women presenting with PHPT.
原发性甲状旁腺功能亢进症（PHPT）合并骨质疏松症（定义为骨矿物质密度低于正常水平2个标准差以上）的患者需要进行甲状旁腺手术。许多患者是患有复杂医疗问题的老年女性，她们要么不愿意接受手术，要么被认为不适合手术。雌激素替代疗法（ERT）可能是这类患者的一种替代治疗方式。我们研究了15例连续的患有PHPT和骨质疏松症的绝经后女性。第1组包括5名选择接受ERT治疗的女性（结合马雌激素，0.3 - 0.625毫克/天）。另外10名女性接受了成功的甲状旁腺切除术。这10名患者被随机分为第2组（5名患者在术后12个月每天接受两次0.25微克骨化三醇治疗）和第3组（5名患者在术后12个月每天接受1克元素钙治疗）。在治疗前和治疗12个月后，使用双能X线吸收仪（Lunar DPX - L）测量腰椎和股骨颈的骨矿物质密度（BMD）。三组患者在年龄（组平均71.8岁）、基线血清钙（组平均2.77毫摩尔/升）、血清甲状旁腺激素（组平均11.0皮摩尔/升）、腰椎BMD（组平均0.93克/平方厘米）和股骨颈BMD（组平均0.73克/平方厘米）方面没有差异。所有接受手术的患者血清钙均恢复正常，且无一例发生甲状旁腺功能减退。仅接受ERT治疗的患者血清钙出现了不显著的下降。ERT治疗12个月后，腰椎BMD（每年增加5.3%；95%可信区间，1.1%至9.6%）和股骨颈BMD（每年增加5.5%；95%可信区间， - 2.1%至13.2%）显著增加（与治疗前值相比，p < 0.001）。这些BMD的增加与成功接受甲状旁腺切除术后接受骨化三醇治疗或补钙治疗的患者没有显著差异（腰椎BMD每年增加6.2%，95%可信区间3.1%至9.4%；股骨颈BMD每年增加3%，95%可信区间0至6%）。总之，治疗PHPT后腰椎和股骨颈BMD会增加。对于患有PHPT的老年绝经后女性骨质疏松症的治疗，ERT似乎与甲状旁腺切除术（联合骨化三醇或钙剂）一样有效。
