DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201909

The comparison of bone mineral density in primary hyperparathyroidim, vitamin D induced secondary hyperparathyroidism, and patients with both condition: a single center experience

Hande Peynirci, Canan Ersoy, Ayten Girgin, Vildan Gürsoy, Mehmet Ali Asik, Güven Ozkaya, Alpaslan Ersoy

Abstract


Background: To compare bone mineral densities via dual energy X-ray absorptiometry method (DXA) between various hyperparathyroidism (HPT) types such as primary, vitamin D induced secondary, and both conditions.

Methods: Participants who were aged between 18-45 years and had elevated parathyroid hormone levels were included. After initial evaluations, patients were divided into 3 groups according to diagnoses: primary HPT (pHPT), vitamin D induced secondary HPT (sHPT), and combined (primary+secondary) one. In addition to the bone mineral density (BMD), demographic and laboratory datas were recorded.

Results: Of 166 patients, 147 of the patients were female, 19 were male, and average age was 38.10±7.24 years. Significant difference was found in terms of age (p=0.03) between pHPT and sHPT. Blood calcium, PTH, 25-OH vitamin D, and daily urine calcium excretion levels were significantly higher and phosphorus levels were lower in the pHPT group compared to the sHPT and combined disease group. Both T and Z scores of the pHPT group were significantly lower than the sHPT group especially in the lumbar region. However, no significant difference was noted between pHPT and combined disease group with respect to T and Z scores in all regions.

Conclusions: The results of this study indicate that pHPT has a significantly worse impact on skeletal mineral density particularly in the lumbar region than sHPT. The addition of vitamin D deficiency to the clinical picture seems to have no significant influence on BMD in pHPT. To confirm and clarify these findings, prospective studies with larger number of participants are needed.


Keywords


Bone mineral density, Dual energy X-ray absorptiometry hyperparathyroidism, Vitamin D deficiency

Full Text:

PDF

References


Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122-9.

Jamal SA, Miller PD. Secondary and tertiary hyperparathyroidism. J Clin Densitom. 2013;16(1):64-8.

Messa P, Alfieri CM. Secondary and tertiary hyperparathyroidism. Front Horm Res. 2019;51:91-108.

Miguel GA, Carranza FH, Rodriguez JCR, Ramos MA, Pablos DL, Herrero EF, et al. Trabecular Bone Score, Bone Mineral Density and Bone Markers in Patients with Primary Hyperparathyroidism 2 Years After Parathyroidectomy. Hormon Metab Res. 2019;51(3):186-90.

Lee D, Walker MD, Chen HY, Chabot JA, Lee JA, Kuo JH. Bone mineral density changes after parathyroidectomy are dependent on biochemical profile. Surgery. 2019;165(1):107-13.

Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am J Physiol Renal Physiol. 2005;289(1):F8-28.

Jung KY, Hong AR, Lee DH, Kim JH, Kim KM, Shin CS, et al. The natural history and hip geometric changes of primary hyperparathyroidism without parathyroid surgery. J Bone Miner Metab 2017;35(3):278-88.

Silverberg SJ, Locker FG, Bilezikian JP. Vertebral osteopenia: a new indication for surgery in primary hyperparathyroidism. J Clin Endocrinol Metab. 1996;81(11):4007-12.

Lumachi F, Camozzi V, Ermani M, Nardi A, Luisetto G. Lumbar spine bone mineral density changes in patients with primary hyperparathyroidism according to age and gender. Ann N Y Acad Sci. 2007;1117:362-6.

Rolighed L, Vestergaard P, Heickendorff L, Sikjaer T, Rejnmark L, Mosekilde L, et al. BMD improvements after operation for primary hyperparathyroidism. Langenbecks Arch Surg 2013;398(1):113-20.

Hagström E LE, Mallmin H, Rastad J, Hellman P. Positive effect of parathyroidectomy on bone mineral density in mild asymptomatic primary hyperparathyroidism. J Intern Med. 2006;259(2):191-8.

Lundstam K, Heck A, Godang K, Mollerup C, Baranowski M, Pernow Y, et al. Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study). J Bone Miner Res. 2017;32(9):1907-14.

Wood K, Dhital S, Chen H, Sippel RS. What is the utility of distal forearm DXA in primary hyperparathyroidism? Oncolog. 2012;17(3):322-5.

Silverberg SJ, Gartenberg F, Jacobs TP, Shane E, Siris E, Staron RB, et al. Longitudinal measurements of bone density and biochemical indices in untreated primary hyperparathyroidism. J Clin Endocrinol Metab. 1995;80(3):723-8.

Moosgaard B, Vestergaard P, Heickendorff L, Melsen F, Christiansen P, Mosekilde L. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin Endocrinol (Oxf). 2005;63(5):506-13.

Boudou P, Ibrahim F, Cormier C, Sarfati E, Souberbielle JC. A very high incidence of low 25 hydroxy-vitamin D serum concentration in a French population of patients with primary hyperparathyroidism. J Endocrinol Invest. 2006;29(6):511-5.

Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, et al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab. 2000;85(3):1054-8.

Rao DS, Agarwal G, Talpos GB, Phillips ER, Bandeira F, Mishra SK, et al. Role of vitamin D and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: a global perspective. J Bone Miner Res. 2002;17 Suppl 2:N75-80.

Moosgaard B, Christensen SE, Vestergaard P, Heickendorff L, Christiansen P, Mosekilde L. Vitamin D metabolites and skeletal consequences in primary hyperparathyroidism. Clin Endocrinol (Oxf). 2008;68(5):707-15.

Walker MD, Saeed I, Lee JA, Zhang C, Hans D, Lang T, et al. Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism. Osteoporos Int. 2016;27(10):3063-71.

Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ, et al. Vitamin D in Primary Hyperparathyroidism: Effects on Clinical, Biochemical, and Densitometric Presentation. J Clin Endocrinol Metab. 2015;100(9):3443-51.

Carnevale V, Manfredi G, Romagnoli E, De Geronimo S, Paglia F, Pepe J, et al. Vitamin D status in female patients with primary hyperparathyroidism: does it play a role in skeletal damage? Clin Endocrinol (Oxf). 2004;60(1):81-6.