Bisphosphonates can reduce bone hunger after parathyroidectomy in patients with primary hyperparathyroidism and osteitis fibrosa cystica.
Tatiana Clementino Pinto Toscano de França,Luiz Griz,Jorge Pinho,Erik Trovão Diniz,Luena Dias de Andrade,Cynthia Salgado Lucena,Susyane Ribeiro Beserra,Nadja Maria Jorge Asano,Ângela Luzia Branco Pinto Duarte,Francisco Bandeira +9 more
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TLDR
The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.Abstract:
OBJECTIVE: To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica. METHODS: Review of the medical records of six patients using bisphosphonates preoperatively. RESULTS: Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm2 (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm2 (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm2 (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33. CONCLUSION: The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.read more
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Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature.
TL;DR: There is insufficient data-based evidence on the best means to treat, minimise or prevent this severe complication of parathyroidectomy, and preoperative treatment with bisphosphonates has been suggested to reduce post-operative hypocalcaemia, but there are to date no prospective studies addressing this issue.
Journal ArticleDOI
Bone disease in primary hyperparathyroidism
Francisco Bandeira,Natalie E. Cusano,Barbara C. Silva,Sara Cassibba,Clarissa Beatriz Almeida,Vanessa Caroline Costa Machado,John P. Bilezikian +6 more
TL;DR: Bone disease in severe primary hyperparathyroidism is described classically as osteitis fibrosa cystica, and newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.
Journal ArticleDOI
Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review.
TL;DR: This systematic review provides an overview of the existing literature on contemporary pharmaceutical options available for the medical management of primary hyperparathyroidism and demonstrates advantages and drawbacks of the available pharmaceutical options that can prove helpful in the clinical setting.
Journal ArticleDOI
Hyperparathyroidism and Bone Health
Francisco Bandeira,Sara Cassibba +1 more
TL;DR: In asymptomatic PHPT, the absence of clinically significant bone involvement has led to much more data on bone mineral density becoming available by dual X-ray absorptiometry (DXA) and also on new technologies such as trabecular bone score (TBS), which is a gray-level textural analysis of DXA images that provides an indirect index of trABecular microarchitecture.
Journal ArticleDOI
Association between increased serum osteoprotegerin levels and improvement in bone mineral density after parathyroidectomy in hemodialysis patients.
Cai Mei Zheng,Pauling Chu,Chia-Chao Wu,Wen Ya Ma,Kuo Chin Hung,Yung Ho Hsu,Yuh Feng Lin,Liang Kuang Diang,Kuo Cheng Lu +8 more
TL;DR: It is suggested that PTX removes the suppressive effects of high PTH on OPG secretion, resulting in the increased serum OPG levels that may contribute to BMD improvement within the first year after PTX.
References
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Journal ArticleDOI
Hungry bone syndrome: Clinical and biochemical predictors of its occurrence after parathyroid surgery
TL;DR: The hospital course of 218 consecutive patients with primary hyperparathyroidism admitted over a three-year period for parathyroidectomy at the Massachusetts General Hospital was reviewed to determine the incidence and identify the risk factors for the development of the hungry bone syndrome.
Journal ArticleDOI
Alendronate in Primary Hyperparathyroidism: A Double-Blind, Randomized, Placebo-Controlled Trial
Aliya Khan,John P. Bilezikian,Annie W. C. Kung,Mustafa M. Ahmed,Sacha Dubois,Andrew Y. Y. Ho,Debra H. Schussheim,Mishaela R. Rubin,Atif M. Shaikh,Shonni J. Silverberg,Timothy I. Standish,Zareen Syed,Zeba A. Syed +12 more
TL;DR: Alendronate may be a useful alternative to parathyroidectomy in asymptomatic PHPT among those with low BMD and marked reductions in bone turnover markers with rapid decreases in urinary NTX excretion.
Journal ArticleDOI
Primary hyperparathyroidism : New concepts in clinical, densitometric and biochemical features
TL;DR: A number of items were highlighted for further investigation such as pharmacological approaches to controlling hypercalcaemia, elevated PTH levels and maintaining bone density, and Vitamin D looms as an important determinant of the activity of the PHPT state.
Journal ArticleDOI
Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism.
C. C. Chow,W.B. Chan,June K. Y. Li,Norman N. Chan,Michael H.M. Chan,Gary T. C. Ko,K. W. Lo,Clive S. Cockram +7 more
TL;DR: Alendronate improves BMD and reduces bone turnover markers in postmenopausal women with PHP and improved BMD at femoral neck and lumbar spine and increased 24 wk after treatment withdrawal.
Journal ArticleDOI
Vitamin D Deficiency and Primary Hyperparathyroidism
TL;DR: Vitamin D–deficient patients undergoing parathyroidectomy are also at increased risk of postoperative hypocalcemia and “hungry bone syndrome,” which underscores the importance of preoperative assessment of vitamin D status in all patients with primary hyperparathyroidism.