Parathyroidectomy may reverse age-related bone changes
MedWire News: Women who undergo parathyroidectomy (PTX) show selective improvements in bone geometry, strength, and mineral density 1 year after surgery, study findings show.
The research indicates that PTX is able to reverse or at least attenuate age-related changes in these bone parameters, say Stinus Hansen (Odense University Hospital, Denmark) and colleagues writing in the Journal of Bone and Mineral Research.
PTX is thought to bring about changes in skeletal metabolism and pathophysiology but most data is derived from ex-vivo and biopsy studies.
In the current research, Hansen et al used high-resolution peripheral quantitative computed tomography and dual-energy X-ray absorptiometry to assess bone parameters in vivo in 27 women who had undergone PTX for primary hyperparathyroidism (cases) and 31 healthy women matched for age (controls).
The two groups were comparable with respect to weight, height, body mass index (BMI), menopausal status, years since menopause, history of previous fractures, and serum vitamin D levels, note Hansen et al.
Women were imaged at baseline and again 1 year later. During this time, areal bone mineral density (BMD) increased significantly in cases but decreased significantly in controls. The same pattern was seen for measurements at the forearm, spine, and total hip.
Also during follow-up, total bone area was unchanged in both groups. By contrast, cortical thickness and trabecular area were both maintained in cases but declined and increased, respectively, in controls.
Cortical, trabecular, and total bone volumetric BMD all increased significantly in cases but declined in controls; similarly, cancellous architecture (as indicated by trabecular number and spacing) improved in cases but was unchanged or deteriorated slightly in controls.
Bone failure load (estimated using finite element modelling) increased in cases but declined in controls.
Finally, in the group of women who underwent PTX, biochemical markers of bone formation and resorption decreased significantly after surgery. Interestingly, parathyroid hormone levels at baseline correlated positively with volumetric BMD and estimated failure load at follow-up.
The authors say their data indicate that PTX reverses or attenuates age-related bone changes, and conclude: "In this 1-year prospective controlled study, patients with primary hyperparathyroidism had significant changes in cortical and trabecular geometry, density, or microarchitecture in radius and tibia following PTX."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Joanna Lyford