Reviews in Clinical Medicine

Reviews in Clinical Medicine

Evaluation of changes in biochemical parameters and bone mineral densitometry (BMD) following parathyroidectomy in patients with primary hyperparathyroidism

Document Type : Original article

Authors
Sepideh Fattahi 1
Solmaz Hasani 1
Masood Mohebi 1
Negar Morovvat-Dar 2
Farid Qoorchi 2
Moheb Seraj 3
Ghazale Taghavi 4
1 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Social Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Neurosurgery, Neurovascular Section, Mashhad University of Medical Sciences, Mashhad, Iran
4 Student of research committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/rcm.2025.85105.1520
Abstract
Parathyroidectomy for patients with primary hyperparathyroidism (PHPT) has been found to improve bone mineral densitometry (BMD). In this prospective cohort study on the patients with PHPT referred to the Endocrine Clinic of our tertiary center between 2017 and 2018 and divided into two groups of a surgery group (SG) and a non-surgery group (NSG). The BMD, the serum levels of calcium, phosphorus, creatinine, 25(OH) D, albumin, and Parathyroid hormone changes were analyzed at baseline and two years of follow-up. 30 patients were included in the study; 20 patients in SG and 10 patients in the NSG In the SG, the levels of 25(OH) D and phosphorus increased significantly after 2 years (p<0.001). The amount of calcium and PTH also decreased (p<0.001). Moreover, the changes in the parameters after two years in the NSG were not statistically significant. In the SG, the T-score and Z-score significantly increased compared to pre-operative values in the area of lumbar vertebrae (p<0.01)). In the distal region of the radius, the T-score increased significantly (p<0.05) and the Z-score increase was at the border of significance (p=0.048). The parameters had a non-significant increase in the femoral neck. Our study demonstrated that parathyroidectomy for patients with primary hyperparathyroidism enhances the BMD of the lumbar vertebrae and the distal radius and a clear improvement and the biochemical parameters reached the normal level.
Keywords
Hyperparathyroidism
Parathyroidectomy
Bone mineral densitometry
  1. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-125. doi: 10.1038/nrendo.2017.104. Epub 2017 Sep 8. PMID: 28885621; PMCID: PMC6037987.
  2. Minisola S, Arnold A, Belaya Z, Brandi ML, Clarke BL, Hannan FM, Hofbauer LC, Insogna KL, Lacroix A, Liberman U, Palermo A, Pepe J, Rizzoli R, Wermers R, Thakker RV. Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism. J Bone Miner Res. 2022 Nov;37(11):2315-2329. doi: 10.1002/jbmr.4665. Epub 2022 Oct 17. PMID: 36245271; PMCID: PMC10092691.
  3. Kaszczewska M, Popow M, Chudziński W, Kaszczewska J, Bogdańska M, Podgórska J, Czarniecka A, Gałązka Z. A Woman with a 27-Year History of Hyperparathyroidism and Hypercalcemia Who Was Diagnosed with Low-Grade Parathyroid Carcinoma. Am J Case Rep. 2021 Mar 11;22:e930301. doi: 10.12659/AJCR.930301. PMID: 33707407; PMCID: PMC7957837.
  4. Marques JVO, Moreira CA (2020) Primary hyperparathyroidism. Best Practice & Research Clinical Rheumatology 34: 101514
  5. Goltzman D (2018) Physiology of Parathyroid Hormone. Endocrinol Metab Clin North Am 47: 743-758
  6. Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VC, Bilezikian JP. Bone disease in primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2014 Jul;58(5):553-61. doi: 10.1590/0004-2730000003381. PMID: 25166047; PMCID: PMC4315357.
  7. Lee JY, Shoback DM. Familial hypocalciuric hypercalcemia and related disorders. Best Pract Res Clin Endocrinol Metab. 2018 Oct;32(5):609-619. doi: 10.1016/j.beem.2018.05.004. Epub 2018 May 26. PMID: 30449544; PMCID: PMC6767927.
  8. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solórzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-968. doi: 10.1001/jamasurg.2016.2310. PMID: 27532368.
  9. Hassani S, Afkhamizadeh M, Teimouri A, Najaf Najafi M, Vazifeh Mostaan L, Mohebbi M. Evaluation of Serum Level of FGF23 and 1,25(OH)2D3in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy. Int J Gen Med. 2020 Jun 11;13:289-295. doi: 10.2147/IJGM.S253246. PMID: 32606893; PMCID: PMC7295333.
  10. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, Thakker R, D'Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT Jr, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017 Jan;28(1):1-19. doi: 10.1007/s00198-016-3716-2. Epub 2016 Sep 9. PMID: 27613721; PMCID: PMC5206263.
  11. Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman-Dijkstra NM, Cardoso L, Hannan FM, Cetani F, Sikjær T, Formenti AM, Björnsdottir S, Schalin-Jantti C, Belaya Z, Gibb FW, Lapauw B, Amrein K, Wicke C, Grasemann C, Krebs M, Ryhänen EM, Makay O, Minisola S, Gaujoux S, Bertocchio JP, Hassan-Smith ZK, Linglart A, Winter EM, Kollmann M, Zmierczak HG, Tsourdi E, Pilz S, Siggelkow H, Gittoes NJ, Marcocci C, Kamenicky P; 2021 PARAT Working Group. European Expert Consensus on Practical Management of Specific Aspects of Parathyroid Disorders in Adults and in Pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders. Eur J Endocrinol. 2022 Jan 13;186(2):R33-R63. doi: 10.1530/EJE-21-1044. PMID: 34863037; PMCID: PMC8789028.
  12. Agrawal K, Arya AK, Sood A, Kumari P, Singh P, Sapara M, Rastogi A, Behera A, Bhadada SK. A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy. Clin Endocrinol (Oxf). 2021 Mar;94(3):371-376. doi: 10.1111/cen.14311. Epub 2020 Sep 3. PMID: 32789888.
  13. de la Plaza Llamas R, Ramia Ángel JM, Arteaga Peralta V, García Amador C, López Marcano AJ, Medina Velasco AA, González Sierra B, Manuel Vázquez A, Latorre Fragua RA. Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):659-669. doi: 10.1007/s00405-017-4836-9. Epub 2017 Dec 5. PMID: 29209851.
  14. Miguel GA, Carranza FH, Rodríguez JCR, Ramos MA, Pablos DL, Herrero EF, Díaz-Guerra GM. Trabecular Bone Score, Bone Mineral Density and Bone Markers in Patients with Primary Hyperparathyroidism 2 Years After Parathyroidectomy. Horm Metab Res. 2019 Mar;51(3):186-190. doi: 10.1055/a-0850-8679. Epub 2019 Mar 12. PMID: 30861565.
  15. Hong AR, Lee JH, Kim JH, Kim SW, Shin CS. Effect of Endogenous Parathyroid Hormone on Bone Geometry and Skeletal Microarchitecture. Calcif Tissue Int. 2019 Apr;104(4):382-389. doi: 10.1007/s00223-019-00517-0. Epub 2019 Jan 18. PMID: 30659307.
  16. Lu S, Gong M, Zha Y, Cui A, Chen C, Yang H, Sun W, Hua K, Tian W, Jiang X. Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism. J Int Med Res. 2020 Oct;48(10):300060520964698. doi: 10.1177/0300060520964698. PMID: 33135515; PMCID: PMC7780563.
  17. Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863.
  18. Nordenström E, Westerdahl J, Lindergård B, Lindblom P, Bergenfelz A. Multifactorial risk profile for bone fractures in primary hyperparathyroidism. World J Surg. 2002 Dec;26(12):1463-7. doi: 10.1007/s00268-002-6433-2. Epub 2002 Sep 26. PMID: 12297914.
  19. Fleischer J, Stein EM, Bessler M, Della Badia M, Restuccia N, Olivero-Rivera L, McMahon DJ, Silverberg SJ. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008 Oct;93(10):3735-40. doi: 10.1210/jc.2008-0481. Epub 2008 Jul 22. PMID: 18647809; PMCID: PMC2579647.
  20. 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 Jan;165(1):107-113. doi: 10.1016/j.surg.2018.04.065. Epub 2018 Oct 14. PMID: 30327189.
  21. Ohe MN, Bonanséa TCP, Santos RO, Neves MCD, Santos LM, Rosano M, Kunii IS, Castro ML, Vieira JGH. Prediction of bone mass changes after successful parathyroidectomy using biochemical markers of bone metabolism in primary hyperparathyroidism: is it clinically useful? Arch Endocrinol Metab. 2019 Jul 29;63(4):394-401. doi: 10.20945/2359-3997000000154. PMID: 31365627; PMCID: PMC10528649.
  22. Nakaoka D, Sugimoto T, Kobayashi T, Yamaguchi T, Kobayashi A, Chihara K. Prediction of bone mass change after parathyroidectomy in patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2000 May;85(5):1901-7. doi: 10.1210/jcem.85.5.6604. PMID: 10843172.
  23. Cipriani C, Biamonte F, Costa AG, Zhang C, Biondi P, Diacinti D, Pepe J, Piemonte S, Scillitani A, Minisola S, Bilezikian JP. Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J Clin Endocrinol Metab. 2015 Apr;100(4):1309-15. doi: 10.1210/jc.2014-3708. Epub 2015 Feb 3. PMID: 25646791; PMCID: PMC4399306.
  24. Choe HJ, Koo BK, Yi KH, Kong SH, Kim JH, Shin CS, Chai JW, Kim SW. Skeletal effects of combined bisphosphonates treatment and parathyroidectomy in osteoporotic patients with primary hyperparathyroidism. J Bone Miner Metab. 2022 Mar;40(2):292-300. doi: 10.1007/s00774-021-01279-2. Epub 2021 Nov 10. PMID: 34761302.
Reviews in Clinical Medicine
Volume 12, Issue 2
Spring 2025
Pages 89-93