Abstract
There have been few reports on changes in bone geometry in asymptomatic patients with primary hyperparathyroidism (PHPT) not treated surgically. We reviewed the records concerning biochemical parameters, bone mineral density (BMD), and hip geometry in 119 PHPT patients who did not undergo parathyroidectomy, followed up at one of three hospitals affiliated to Seoul National University from 1997 to 2013. We examined biochemical parameters over 7 years and BMD and hip geometry over 5 years of follow-up. We further compared hip geometry and BMD derived from dual-energy X-ray absorptiometry (DXA) between patients and age- and sex-matched controls. The median follow-up duration of 56 patients for whom surgery was not indicated was 33.9 months (range 11.2–131.2 months), and 19.6 % of these patients had disease progression during follow-up. Serum calcium levels remained stable for 7 years in all 119 patients. From a comparison of the PHPT patients for whom surgery was not indicated with controls, both male and postmenopausal female patients had significantly lower hip axis length (P < 0.001), cross-sectional moment of inertia (P < 0.001), cross-sectional area (P < 0.001), and section modulus (P < 0.001). In addition, cortical thickness was significantly decreased at 5 years compared with individual baseline values (P = 0.003). However, there was no significant change in BMD for the duration of the 5-year follow-up. DXA-derived geometry can detect skeletal change in asymptomatic PHPT patients for whom surgery is not indicated, supporting the concept that even mild PHPT can eventually compromise the cortical bones. Hip geometry is a potential tool for monitoring skeletal complication in asymptomatic PHPT patients.
Similar content being viewed by others
References
Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341:1249–1255
Cho ECJ, Yoon SY, Lee GT, Ku YH, Kim HI, Lee MC, Lee GH, Kim MJ (2014) Preoperative localization and intraoperative parathyroid hormone assay in Korean patients with primary hyperparathyroidism. Endocr Metab 29:464–469
Ji L (2011) Current understanding and treatment of primary hyperparathyroidism. Endocr Metab 26:109–117
Khosla S, Melton LJ 3rd, Wermers RA, Crowson CS, O’Fallon W, Riggs B (1999) Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res 14:1700–1707
Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L (2000) Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ 321:598–602
Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93:3462–3470
Kaji H, Yamauchi M, Nomura R, Sugimoto T (2009) Two-year longitudinal changes in forearm cortical bone geometry in postmenopausal women with mild primary hyperparathyroidism without parathyroidectomy. Exp Clin Endocrinol Diabetes 117:633–636
Siilin H, Lundgren E, Mallmin H, Mellstrom D, Ohlsson C, Karlsson M, Orwoll E, Ljunggren O (2011) Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World J Surg 35:1266–1272
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99:3561–3569
Beck TJ, Mourtada FA, Ruff CB, Scott WW Jr, Kao G (1998) Experimental testing of a DEXA-derived curved beam model of the proximal femur. J Orthop Res 16:394–398
Beck T (2003) Measuring the structural strength of bones with dual-energy X-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int 14:S81–S88
Ahlborg HG, Nguyen ND, Nguyen TV, Center JR, Eisman JA (2005) Contribution of hip strength indices to hip fracture risk in elderly men and women. J Bone Miner Res 20:1820–1827
El-Kaissi S, Pasco JA, Henry MJ, Panahi S, Nicholson JG, Nicholson GC, Kotowicz MA (2005) Femoral neck geometry and hip fracture risk: the Geelong osteoporosis study. Osteoporos Int 16:1299–1303
Faulkner KG, Wacker WK, Barden HS, Simonelli C, Burke PK, Ragi S, Del Rio L (2006) Femur strength index predicts hip fracture independent of bone density and hip axis length. Osteoporos Int 17:593–599
Leslie WD, Pahlavan PS, Tsang JF, Lix LM, Manitoba Bone Density P (2009) Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort. Osteoporos Int 20:1767–1774
Charopoulos I, Tournis S, Trovas G, Raptou P, Kaldrymides P, Skarandavos G, Katsalira K, Lyritis GP (2006) Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women. J Clin Endocrinol Metab 91:1748–1753
Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304
Hansen S, Beck Jensen JE, Rasmussen L, Hauge EM, Brixen K (2010) Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: a case-control study using HR-pQCT. J Bone Miner Res 25:1941–1947
Briot K, Benhamou CL, Roux C (2012) Hip cortical thickness assessment in postmenopausal women with osteoporosis and strontium ranelate effect on hip geometry. J Clin Densitom 15:176–185
Laskey MA, Price RI, Khoo BC, Prentice A (2011) Proximal femur structural geometry changes during and following lactation. Bone 48:755–759
Bonnick SL (2007) HSA: beyond BMD with DXA. Bone 41:S9–S12
Khoo BC, Beck TJ, Qiao QH, Parakh P, Semanick L, Prince RL, Singer KP, Price RI (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121
Tournis S, Antoniou JD, Liakou CG, Christodoulou J, Papakitsou E, Galanos A, Makris K, Marketos H, Nikopoulou S, Tzavara I, Triantafyllopoulos IK, Dontas I, Papaioannou N, Lyritis GP, Alevizaki M (2015) Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression. Clin Endocrinol 82:197–204
Anitha D, Kim KJ, Lim SK, Lee T (2014) Comparison of buckling ratio and finite element analysis of femoral necks in post-menopausal women. J Menopausal Med 20:52–56
Lewiecki EM, Miller PD (2013) Skeletal effects of primary hyperparathyroidism: bone mineral density and fracture risk. J Clin Densitom 16:28–32
Hansen S, Hauge EM, Rasmussen L, Jensen JE, Brixen K (2012) Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: a one-year prospective controlled study using high-resolution peripheral quantitative computed tomography. J Bone Miner Res 27:1150–1158
Beck TJ, Ruff CB, Warden KE, Scott WW Jr, Rao GU (1990) Predicting femoral neck strength from bone mineral data. A structural approach. Invest Radiol 25:6–18
Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, Cummings SR (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23:1892–1904
Pontikides N, Karras S, Kaprara A, Anagnostis P, Mintziori G, Goulis DG, Memi E, Krassas G (2014) Genetic basis of familial isolated hyperparathyroidism: a case series and a narrative review of the literature. J Bone Miner Metab 32:351–366
Acknowledgment
This work was supported by a grant from Seoul National University Hospital (no. 042012-0450).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Jung, K.Y., Hong, A.R., Lee, D.H. et al. The natural history and hip geometric changes of primary hyperparathyroidism without parathyroid surgery. J Bone Miner Metab 35, 278–288 (2017). https://doi.org/10.1007/s00774-016-0751-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00774-016-0751-1