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Parathyroidectomy improves bone strength in primary hyperparathyroidism

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October 25, 2017

John P. Bilezikian
John P. Bilezikian

Adults with primary hyperparathyroidism who undergo parathyroidectomy have improved estimated bone strength 2 years after surgery, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

“The study provides new information about improvements in skeletal microstructure and bone strength following successful parathyroidectomy in patients with primary hyperparathyroidism,” John P. Bilezikian, MD, vice-chair for international research and education, chief emeritus of the division of endocrinology, and director of the metabolic bone diseases unit at the College of Physicians and Surgeons at Columbia University, told Endocrine Today. “The results of the study indicate that skeletal microstructure, using non-invasive high resolution of CT imaging, improves specific aspects of both cortical and trabecular microstructure.”

Bilezikian and colleagues evaluated 29 adults (mean age, 61.8 years; 72.4% women) with primary hyperparathyroidism who underwent high-resolution peripheral quantitative CT at baseline and 6, 12, 18 and 24 months after parathyroidectomy. Researchers sought to identify changes in skeletal microstructure. The main outcome measures included volumetric bone mineral density, microarchitectural indices and finite element analysis at the distal radius and tibia.

In the total, cortical and trabecular radius, there were no changes at any time during the 24 months. However, increases were observed for total volumetric BMD (2.8%), trabecular volumetric BMD (3.8%; P < .0001 for both), cortical volumetric BMD (1.5%; P < .05), meta-trabecular density (2.9%; P < .0001), inner trabecular density (5.8%; P < .05), cortical thickness (1.1%; P < .01) and trabecular bone volume (3.8%; P < .0001) at 24 months.

At the tibia, increases were observed for cortical area (4.5%; P < .0001), total volumetric BMD (4.4%), cortical BMD (4%), trabecular BMD (3.2%; P < .0001 for all three), meta-trabecular density (2.4%; P < .0001), inner trabecular density (4.9%; P < 001) and trabecular bone volume (3.2%; P < .0001) at 24 months. A decrease was observed for trabecular area (0.8%; P < .0001), and total area remained unchanged.

“The results provide key information related to improvements in bone strength after successful parathyroid surgery,” Bilezikian said. “It adds importantly to information, long known, that bone density improves but this is one of the only studies to document also and importantly that bone strength also improves. It is also consistent with recent studies showing reduced fracture risk after parathyroid surgery.” – by Amber Cox

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John P. Bilezikian, MD, can be reached through the media department of Columbia University Medical Center at cumcnews@columbia.edu.

Disclosures: Bilezikian reports he is a consultant for Amgen, Radius, Shire and Ultragenyx. Please see the study for all other authors’ relevant financial disclosures.