Total parathyroidectomy (PTX) without autotransplantation may improve bone mineral density in patients with end-stage renal disease and secondary hyperparathyroidism (SHPT), new data suggest.
Reduced bone mineral density (BMD) in patients with SHPT may lead to an increase in osteoporosis risk, fracture, and mortality.
In a study of 34 patients (mean age 49.7 years) who underwent successful total PTX without autotransplantation, Li Fang, MD, of the Affiliated Hospital of Nantong University, Jiangsu Province, China, and colleagues evaluated BMD changes and associated factors. The investigators reviewed preoperative and postoperative dual energy X-ray absorptiometry (DEXA) scans.
At baseline, the prevalence of osteoporosis appeared to be much higher in the load-bearing lumbar spine than in the hip, the investigators reported in BMC Nephrology (2018;19:142). This varied greatly even between different lumbar vertebrae. DEXA revealed that 32.4% of patients had osteoporosis at L4, whereas 11.8% had osteoporosis at L1.
After curative total PTX without autotransplantation, BMD improved significantly in both the lumbar spine and hip overall. The largest increase in BMD occurred at L4 vertebrae, which had the lowest preoperative BMD.
At L4, 86.2% of patients experienced significant improvement (greater than 5%) in BMD following surgery, 5.9% experienced moderate improvement (0.1%–5%), and 5.9% experienced a decline in BMD.
In the hip region, 76.5% of patients had significant improvement at the femoral neck, site of the highest frequency of osteoporosis (23.5%).
“After successful total parathyroidectomy without autotransplantation, further bone loss could be halted and BMD subsequently increased at nearly all skeletal sites,” the investigators wrote. “The lumbar spine showed a greater increase in BMD than the hip and the greatest increase in BMD was observed in the weight-bearing L4. This indicated that the sites with lowest BMD might benefit most from surgical cure.”
Fang L, Wu J, Luo J, et al. Changes in bone mineral density after total parathyroidectomy without autotransplantation in the end-stage renal disease patients with secondary hyperparathyroidism. BMC Nephrol. 2018;19:142.