Total Parathyroidectomy for Refractory SHPT Improves Bone Metabolism
Bone mineral density in the lumbar spine and femoral neck increased over time in hemodialysis patients who underwent total parathyroidectomy without autotransplantation.
New findings suggest total parathyroidectomy (TPTx) without autotransplantation improves bone metabolism and dynamics in maintenance hemodialysis patients with refractory secondary hyperparathyroidism (SHPT).
Positive changes in bone metabolism and bone mineral density (BMD) were observed in 31 Chinese patients (average age 54.7 years) who underwent TPTx without autotransplantation, Zhongxin Li, MD, and collaborators from Capital Medical University in Beijing, reported online in the Scandinavian Journal of Clinical and Laboratory Investigation. For 5 patients, only 2–3 parathyroid glands were located and removed or residual glands were suspected.
For all but 1 patient, intact parathyroid hormone (PTH) levels fell after surgery, and related parameters returned to more normal levels over 48 months of follow up. Hypercalcemia and hyperphosphatemia resolved. Transient hypocalcemia was successfully treated with oral calcium and calcitriol. Serum alkaline phosphatase decreased starting 3 months after surgery. Following TPTx, significantly fewer patients reported symptoms of bone pain (39% vs 3%) and pruritus (33% vs 10%).
Abnormal bone biomarker levels prior to surgery suggested increased rates of bone synthesis and catabolism in SHPT. During the 48 months of follow-up, the investigators observed significant reductions in serum β-crosslaps (β-CTX), osteocalcin (OC), and procollagen type I amino-terminal propeptide (PINP). Serum sclerostin (SOST) increased starting a month after surgery, which supports PTH's role in inhibiting SOST expression. BMD increased in both the lumbar spine and femoral neck after TPTx.
Ma L, Zhao S and Li Z. Effects of parathyroidectomy on bone metabolism in haemodialysis patients with secondary hyperparathyroidism, Scandinavian. J Clin Lab Invest. doi: 10.1080/00365513.2017.1354256