Impact of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism

doi:10.3877/cma.j.issn.1674-0785.2023.06.014

Abstract

Abstract:

Objective

To investigate the effect of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism.

Methods

The clinical data of 61 patients with secondary hyperparathyroidism who underwent parathyroidectomy at China-Japan Friendship Hospital from July 2015 to July 2017 were retrospectively analyzed. The changes in bone mineral density and bone metabolism indexes before and one year after surgery were investigated.

Results

On the first day post-operation, the levels of blood calcium and intact parathyroid hormone (iPTH) significantly decreased (P＜0.001 for both), while the changes in blood phosphorus and alkaline phosphatase (ALP) after surgery were not significant (P＞0.05 for both). One year after surgery, the serum tartrate resistant acid phosphatase (TRACP) levels of the patients decreased from 6.90 (4.69, 10.28) U/L to 2.50 (1.97, 3.13) U/L (P＜0.001); the serum C-terminal cross-linked peptide of collagen type I (CTX-I) levels decreased from 2.27(1.46, 3.05) μg/L before the operation to 0.36 (0.23, 0.96) μg/L (P＜0.001); serum procollagen type 1 aminoterminal propeptide (P1NP) levels decreased from 1062.00 (438.30, 1200.00) μg/L to 168.70 (116.30, 342.00) μg/L (P＜0.001); serum bone-specific alkaline phosphatase (BAP) levels decreased from 60.00 (33.36, 90.00) μg/L to 12.44 (10.95, 16.48) μg/L (P＜0.001); however, there was no significant change in serum N-terminal midfragment of osteocalcin (N-MID-OC) before and after operation (P=0.499). One year after surgery, the bone mineral density (BMD) of lumbar spine 1-4 (L_1-4) increased from 1.02 g/cm² to 1.14 g/cm² (P=0.002); L_1-4 T score increased from -0.76±1.70 to 0.28±1.70 (P＜0.001); the total hip BMD and T score increased significantly from 0.76 (0.67, 0.88) g/cm² to 0.87 (0.76, 1.00) g/cm², and from -1.70 (-2.40, -0.80) to -0.75 (-1.52, 0.20), respectively (P＜0.001 for both).

Conclusion

Parathyroidectomy can improve bone metabolism and increase bone mineral density in patients with secondary hyperparathyroidism.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Bone mineral density, Bone metabolism

Jiajun Zhou, Yongwu Yu, Han Zhou, Ling Zhang. Impact of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 706-710.

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Figures/Tables 4

References 13

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项目	结果
例数（男/女）	61（28/33）
年龄（岁）^a	51.0（37.0，57.0）
透析龄（月）^a	96.0（72.0，129.0）
原发病［例（%）］
慢性肾衰竭	38（62.3）
慢性肾小球肾炎	10（16.4）
原发性高血压	9（14.8）
过敏性紫癜	1（1.6）
多囊肾其他	1（1.6） 2（3.3）
术式［例（%）］
甲状旁腺全切术	45（73.8）
甲状旁腺次全切除术	16（26.2）

项目	结果
例数（男/女）	61（28/33）
年龄（岁）^a	51.0（37.0，57.0）
透析龄（月）^a	96.0（72.0，129.0）
原发病［例（%）］
慢性肾衰竭	38（62.3）
慢性肾小球肾炎	10（16.4）
原发性高血压	9（14.8）
过敏性紫癜	1（1.6）
多囊肾其他	1（1.6） 2（3.3）
术式［例（%）］
甲状旁腺全切术	45（73.8）
甲状旁腺次全切除术	16（26.2）

项目	术前	术后第1天	H/t值	P值
血钙（mmol/L）^a	2.6（2.4，2.7）	2.1（1.9，2.4）	33.137	＜0.001
血磷（mmol/L）^b	2.15±0.55	2.03±0.60	1.275	0.261
ALP（U/L）^a	234（125，541）	174（127，438）	0.572	0.449
iPTH（ng/L）^a	1 714.0（934.0，3249.0）	10.3（4.2，28.8）	81.691	＜0.001

项目	术前	术后第1天	H/t值	P值
血钙（mmol/L）^a	2.6（2.4，2.7）	2.1（1.9，2.4）	33.137	＜0.001
血磷（mmol/L）^b	2.15±0.55	2.03±0.60	1.275	0.261
ALP（U/L）^a	234（125，541）	174（127，438）	0.572	0.449
iPTH（ng/L）^a	1 714.0（934.0，3249.0）	10.3（4.2，28.8）	81.691	＜0.001

项目	术前	术后	H值	P值
TRACP（U/L）	6.90（4.69，10.28）	2.50（1.97，3.13）	43.774	＜0.001
CTX-I（μg/L）	2.27（1.46，3.05）	0.36（0.23，0.96）	48.171	＜0.001
PINP（μg/L）	1062（438，1200）	169（116，342）	51.381	＜0.001
BAP（μg/L）	60.00（33.36，90.00）	12.44（10.95，16.48）	53.395	＜0.001
N-MID-OC（μg/L）	35.96（28.73，55.37）	35.88（26.95，44.19）	0.457	0.499

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