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Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective

  • Epidemiology and Pathophysiology (G El-Hajj Fuleihan and D Shoback, Section Editors)
  • Published:
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Abstract

Purpose of Review

Hyperparathyroidism may be due to an autonomous hypersecretion of parathyroid hormone (PTH) or occurs in response to a number of physiological stimuli. A number of recent findings have provided new insights into the importance of the calcium-parathyroid-vitamin D axis to bone in normal physiology and pathological conditions.

Recent Findings

PTH is known to affect bone microarchitecture with different effects on cortical and trabecular bone compartments. In trabecular bone, PTH may exert anabolic effects, whereas PTH promotes bone resorption in cortical bone. Vertebral fractures are prevalent in primary hyperparathyroidism (PHPT), and patients seem to fracture at higher values of bone mineral density (BMD) than patients with osteoporosis. This may be explained by changes in bone microarchitecture, which cannot be detected by measuring BMD. Even in mild PHPT, bone seems to benefit from parathyroidectomy. In secondary hyperparathyroidism, bone seems much more susceptible to fracture with insufficient levels of vitamin D compared with a replete vitamin status. If elevated PTH levels cannot be explained by conditions known to cause secondary hyperparathyroidism, the condition is termed normocalcemic PHPT, which also has been associated with an increased risk of fractures.

Summary

Hyperparathyroidism is harmful to bone, which is why it is of importance to normalize PTH levels either by parathyroidectomy in PHPT or by counteracting conditions known to increase PTH in secondary hyperparathyroidism.

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  1. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark

    Lars Rejnmark & Henriette Ejlsmark-Svensson

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Lars Rejnmark

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Rejnmark, L., Ejlsmark-Svensson, H. Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective. Curr Osteoporos Rep 18, 103–114 (2020). https://doi.org/10.1007/s11914-020-00574-7

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