Lafforgue P, Pham T, Denizot A, Daumen-Legré V, Acquaviva P C
Department of Rheumatology, La Timone Teaching Hospital, Marseille, France.
Rev Rhum Engl Ed. 1996 Jul-Sep;63(7-8):475-9.
Primary hyperparathyroidism causes excessive bone resorption with a decrease in bone mineral density. Fractures of the vertebras and appendicular bones, however, seem uncommon, even in the long term. We report three patients who presented with bone insufficiency fractures as the inaugural symptom of primary hyperparathyroidism. The three patients were women, aged 62, 65 and 86 years, respectively, who presented with fractures of the medial tibial plateau, femoral neck of femoral neck and tarsus. Laboratory tests showed hypercalcemia, hypophosphatemia and elevated parathyroid hormone levels. Apart from confusion in the 86-year-old patient, there were no clinical manifestations. A bone biopsy obtained in one patient showed increased resorption parameters with no loss of bone trabecular volume; the two other patients underwent absorptiometry, which disclosed a marked decrease in bone mineral density at the spine and femoral neck. There were no risk factors for osteopenia apart from advanced age and female gender. A parathyroid adenoma was removed surgically in all three cases. Vitamin D deficiency was a concomitant abnormality that probably exacerbated the adverse effects of hyperparathyroidism on the skeleton.
原发性甲状旁腺功能亢进会导致骨吸收过度，骨矿物质密度降低。然而，即使从长期来看，脊椎骨和四肢骨骨折似乎也不常见。我们报告了三例以骨不全骨折为原发性甲状旁腺功能亢进首发症状的患者。这三名患者均为女性，年龄分别为62岁、65岁和86岁，分别表现为胫骨内侧平台骨折、股骨颈骨折和跗骨骨折。实验室检查显示高钙血症、低磷血症和甲状旁腺激素水平升高。除86岁患者出现意识模糊外，无其他临床表现。一名患者进行的骨活检显示骨吸收参数增加，但骨小梁体积未减少；另外两名患者接受了骨密度测定，结果显示脊柱和股骨颈的骨矿物质密度显著降低。除了高龄和女性性别外，没有骨质减少的危险因素。所有三例均通过手术切除甲状旁腺腺瘤。维生素D缺乏是一种伴随的异常情况，可能会加剧甲状旁腺功能亢进对骨骼的不良影响。
