Skeletal disease in primary hyperparathyroidism

S. J. Silverberg, E. Shane, L. De La Cruz, D. W. Dempster, F. Feldman, D. Seldin, T. P. Jacobs, E. S. Siris, M. Cafferty, M. V. Parisien, R. Lindsay, Thomas Clemens, J. P. Bilezikian

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Abstract

Most patients with primary hyperparathyroidism in the 1980s do not have evidence of bone disease when they are evaluated by conventional radiography. We sought to determine whether skeletal involvement can be appreciated when more sensitive techniques, such as bone densitometry and bone biopsy, are utilized. We investigated 52 patients with primary hyperparathyroidism. They had mild hypercalcemia, 2.8 ± 0.03 mmol/liter (11.1 ± 0.1 mg/dl), low normal phosphorus, 0.9 ± 0.03 mmol/liter (2.8 ± 0.1 mg/dl), and no symptoms or specific radiological signs of skeletal involvement. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.54 ± 0.1 g/cm; 79 ± 2% of expected), whereas the site of predominantly cancellous bone, the lumbar spine (1.07 ± 0.03 g/cm2), was normal (95 ± 3% of expected). The site of mixed composition, the femoral neck (0.78 ± 0.14 g/cm2), gave an intermediate value (89 ± 2% of expected). Preferential involvement of cortical bone with apparent preservation of cancellous bone in primary hyperparathyroidism was confirmed by percutaneous bone biopsy. Over 80% of patients had a mean cortical width below the expected mean, whereas cancellous bone volume in over 80% of patients was above the expected mean. The results indicate that the majority of patients with asymptomatic primary hyperparathyroidism have evidence by bone densitometry and bone biopsy for cortical bone disease. The results also indicate that the mild hyperparathyroid state may be protective of cancellous bone. The therapeutic implications of these observations await further longitudinal experience with this study population.

Original languageEnglish (US)
Pages (from-to)283-291
Number of pages9
JournalJournal of Bone and Mineral Research
Volume4
Issue number3
Publication statusPublished - 1989
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

Cite this

Silverberg, S. J., Shane, E., De La Cruz, L., Dempster, D. W., Feldman, F., Seldin, D., ... Bilezikian, J. P. (1989). Skeletal disease in primary hyperparathyroidism. Journal of Bone and Mineral Research, 4(3), 283-291.