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Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease

Valdemarsson, S LU ; Lindergård, B LU ; Tibblin, Sten and Bergenfelz, A LU (1998) In Journal of Internal Medicine 243(2). p.22-115
Abstract

OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.

DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.

SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.

SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.

INTERVENTION: All patients were operated upon and restudied one year later.

MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means... (More)

OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.

DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.

SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.

SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.

INTERVENTION: All patients were operated upon and restudied one year later.

MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA).

RESULTS: Bone formation markers consistently decreased after parathyroid surgery: ALP from 3.51 +/- 0.23 to 2.94 +/- 0.21 microkat L(-1) (P < 0.05), osteocalcin from 6.15 +/- 0.53 to 2.89 +/- 0.23 microg L(-1) (P < 0.001) and PICP from 126.4 +/- 10.9 to 96.0 +/- 6.5 microg L(-1) (P < 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 +/- 0.54 to 3.94 +/- 0.34 microg L(-1) (P < 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25-dihydroxy-vitamin D concentrations.

CONCLUSIONS: pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.

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published
subject
keywords
Absorptiometry, Photon, Adult, Aged, Aged, 80 and over, Bone Density, Bone Remodeling, Bone Resorption, Calcium, Creatinine, Female, Humans, Hyperparathyroidism, Kidney, Male, Middle Aged, Parathyroid Hormone, Phosphates, Radionuclide Imaging, Radius, Severity of Illness Index, Vitamin D, Journal Article
in
Journal of Internal Medicine
volume
243
issue
2
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:0031980914
ISSN
0954-6820
DOI
10.1046/j.1365-2796.1998.00241.x
language
English
LU publication?
no
id
3df07708-2baa-4163-b4eb-c4f5dc0c8201
date added to LUP
2017-05-10 17:38:25
date last changed
2017-05-28 05:00:00
@article{3df07708-2baa-4163-b4eb-c4f5dc0c8201,
  abstract     = {<p>OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.</p><p>DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.</p><p>SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.</p><p>SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.</p><p>INTERVENTION: All patients were operated upon and restudied one year later.</p><p>MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA).</p><p>RESULTS: Bone formation markers consistently decreased after parathyroid surgery: ALP from 3.51 +/- 0.23 to 2.94 +/- 0.21 microkat L(-1) (P &lt; 0.05), osteocalcin from 6.15 +/- 0.53 to 2.89 +/- 0.23 microg L(-1) (P &lt; 0.001) and PICP from 126.4 +/- 10.9 to 96.0 +/- 6.5 microg L(-1) (P &lt; 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 +/- 0.54 to 3.94 +/- 0.34 microg L(-1) (P &lt; 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25-dihydroxy-vitamin D concentrations.</p><p>CONCLUSIONS: pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.</p>},
  author       = {Valdemarsson, S and Lindergård, B and Tibblin, Sten and Bergenfelz, A},
  issn         = {0954-6820},
  keyword      = {Absorptiometry, Photon,Adult,Aged,Aged, 80 and over,Bone Density,Bone Remodeling,Bone Resorption,Calcium,Creatinine,Female,Humans,Hyperparathyroidism,Kidney,Male,Middle Aged,Parathyroid Hormone,Phosphates,Radionuclide Imaging,Radius,Severity of Illness Index,Vitamin D,Journal Article},
  language     = {eng},
  number       = {2},
  pages        = {22--115},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Internal Medicine},
  title        = {Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease},
  url          = {http://dx.doi.org/10.1046/j.1365-2796.1998.00241.x},
  volume       = {243},
  year         = {1998},
}