Skip to main content
SpringerLink
Log in

Effect of parathyroidectomy versus risedronate on volumetric bone mineral density and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

The objective of the study was to evaluate the effect of parathyroidectomy (PTX) versus 35 mg once-weekly (ow) risedronate administration on volumetric bone mineral density (vBMD) and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism (PHPT). Our open-label prospective observational study included 32 postmenopausal women with PHPT as the study group: 16 underwent PTX and 16 were treated with 35 mg ow risedronate for 2 years. We assessed areal BMD (aBMD) by DXA, and vBMD and bone mineral content (BMC) (cortical and trabecular area) by peripheral quantitative computed tomography (pQCT) at the tibia at baseline and at 2 years. Risedronate did not result in any significant change on vBMD and structural pQCT indices. PTX resulted in significant increase in trabecular (trab) BMC (6.44 %) and vBMD (4.64 %), with percent increase being significantly higher than risedronate (p < 0.05). At cortical sites, there was no significant change following PTX. However, the percent change in cortical (cort) vBMD was higher following PTX versus risedronate (0.39 % vs. −0.26 %, p < 0.05). In conclusion, in postmenopausal women with PHPT, PTX is superior to ow risedronate, in terms of improvement of trabecular mineralization and vBMD at the tibia, whereas the effect at cortical sites is less pronounced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mosekilde L (2008) Primary hyperparathyroidism and the skeleton. Clin Endocrinol 69:1–19

    Article  CAS  Google Scholar 

  2. Lewiecki ME (2010) Management of skeletal health in patients with asymptomatic primary hyperparathyroidism. J Clin Densitom 13:324–334

    Article  PubMed  Google Scholar 

  3. Bilezikian JP (2003) Bone strength in primary hyperparathyroidism. Osteoporos Int 14(suppl 5):113–117

    Article  Google Scholar 

  4. Horwitz MJ (2011) What medical options should be considered for the treatment of primary hyperparathyroidism? Clin Endocrinol 75:592–595

    Article  CAS  Google Scholar 

  5. Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L (2000) Cohort study of fracture before and after surgery for primary hyperparathyroidism. Br Med J 321:598–602

    Article  CAS  Google Scholar 

  6. Vestergaard P, Mosekilde L (2004) Parathyroid surgery is associated with a decreased risk of hip and upper arm fractures in primary hyperparathyroidism: a controlled cohort study. J Int Med 255:108–114

    Article  CAS  Google Scholar 

  7. Kaji H, Yamauchi M, Nomura R, Sugimoto T (2008) Improved peripheral cortical bone geometry after surgical treatment of primary hyperparathyroidism in postmenopausal women. J Clin Endocrinol Metab 93:3045–3050

    Article  CAS  PubMed  Google Scholar 

  8. Hansen S, Hauge EM, Rasmussen L, Beck 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

    Article  PubMed  Google Scholar 

  9. Sankaran S, Gamble G, Bolland M, Reid IR, Grey A (2010) Skeletal effects of interventions in mild primary hyperparathyroidism: a meta-analysis. J Clin Endocrinol Metabol 95:1653–1662

    Article  CAS  Google Scholar 

  10. Bilezikian JP, Potts JT, Fuleihan EHJ, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg SJ, Udelsman R, Well SA (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metabol 87:5353–5361

    Article  CAS  Google Scholar 

  11. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification and stratification 2002

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. Chen Q, Kaji H, Iu MF, Nomura R, Sowa H, Yamauchi M, Tsukamoto T, Sugimoto T, Chihara K (2003) Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bonegeometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab 88:4655–4658

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Reasner CA, Stone MD, Hosking DJ, Ballah A, Mundy GR (1993) Acute changes in calcium homeostasis during treatment of primary hyperparathyroidism with risedronate. J Clin Endocrinol Metab 77:1067–1071

    CAS  PubMed  Google Scholar 

  16. Eastell R, Walsh JS, Watts NB, Siris E (2011) Bisphosphonates for postmenopausal osteoporosis. Bone (NY) 49:82–88

    Article  CAS  Google Scholar 

  17. Allen MR, Burr DB (2011) Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don’t know. Bone (NY) 49:56–65

    Article  CAS  Google Scholar 

  18. Borah B, Dufresne T, Nurre J, Phipps R, Chmielewski P, Wagner L, Lundy M, Bouxsein M, Zebaze R, Seeman E (2010) Risedronate reduces intracortical porosity in women with osteoporosis. J Bone Miner Res 25:41–47

    Article  CAS  PubMed  Google Scholar 

  19. Schneider PF, Fischer M, Allolio B, Felsenberg D, Schroder U, Semler J, Ittner JR (1999) Alendronate increases bone density and bone strength at the distal radius in postmenopausal women. J Bone Miner Res 14:1387–1393

    Article  CAS  PubMed  Google Scholar 

  20. Burghardt AJ, Kazakia GJ, Sode M, de Papp AE, Link TM, Majumdar S (2010) A longitudinal HR-pQCT study of alendronate treatment in postmenopausal women with low bone density: relations among density, cortical and trabecular microarchitecture, biomechanics, and bone turnover. J Bone Miner Res 25:2558–2571

    Article  PubMed Central  PubMed  Google Scholar 

  21. 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

    Article  CAS  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89:5415–5422

    Article  CAS  PubMed  Google Scholar 

  24. Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud A, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T; on behalf of the SIPH Study Group (2007) Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab 92:1687–1692

    Google Scholar 

  25. Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92:3114–3121

    Article  CAS  PubMed  Google Scholar 

  26. Peacock M, Bolognese MA, Borofsky M, Scumpia S, Sterling LR, Cheng S, Shoback D (2009) Cinacalcet treatment of primary hyperparathyroidism: biochemical and bone densitometric outcomes in a five-year study. J Clin Endocrinol Metab 94:4860–4867

    Article  CAS  PubMed  Google Scholar 

  27. Eastell R, Arnold A, Brandi ML, Brown EM, D’Amour P, Hanley DA, Rao DS, Rubin MR, Goltzman D, Silverberg SJ, Marx SJ, Peacock M, Mosekilde L, Bouillon R, Lewiecki EM (2009) Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:340–350

    Article  CAS  PubMed  Google Scholar 

  28. Grey A, Lucas J, Horne A, Gamble G, Davidson JS, Reid IR (2005) Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab 90:2122–2126

    Article  CAS  PubMed  Google Scholar 

  29. Jorde R, Szumlas K, Haug E, Sundsfjord J (2002) The effect of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake. Eur J Nutr 41:258–263

    Article  CAS  PubMed  Google Scholar 

  30. Locker FG, Silverberg SJ, Bilezikian JP (1997) Optimal dietary calcium intake in primary hyperparathyroidism. Am J Med 102:543–550

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The research was funded by the University of Athens. We thank George Kiniklis for performing the pQCT. Dr. S. Tournis and Dr. E. Fakidari contributed equally to the preparation of the manuscript.

Conflict of interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, University of Athens, KAT Hospital, 10 Athinas Str. Kifissia, 14561, Athens, Greece

    Symeon Tournis, Eleni Fakidari, Ismene Dontas, Chrysoula Liakou, Julia Antoniou, Antonis Galanos, Katerina Katsalira, George Trovas, George P. Lyritis & Nikolaos Papaioannou

  2. Biochemistry Department, KAT Hospital, 14561, Athens, Greece

    Helen Marketou & Konstantinos Makris

Authors
  1. Symeon Tournis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleni Fakidari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ismene Dontas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chrysoula Liakou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julia Antoniou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonis Galanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Helen Marketou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Konstantinos Makris
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Katerina Katsalira
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. George Trovas
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. George P. Lyritis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nikolaos Papaioannou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Symeon Tournis.

About this article

Cite this article

Tournis, S., Fakidari, E., Dontas, I. et al. Effect of parathyroidectomy versus risedronate on volumetric bone mineral density and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism. J Bone Miner Metab 32, 151–158 (2014). https://doi.org/10.1007/s00774-013-0473-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-013-0473-6

Keywords

Search

Navigation