Impact of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism
Objective:To investigate the effect of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism.Methods:The clinical data of 61 patients with secondary hyperparathyroidism who underwent parathyroidectomy at China-Japan Friendship Hospital from July 2015 to July 2017 were retrospectively analyzed. The changes in bone mineral density and bone metabolism indexes before and one year after surgery were investigated.Results:On the first day post-operation, the levels of blood calcium and intact parathyroid hormone (iPTH) significantly decreased (P＜0.001 for both), while the changes in blood phosphorus and alkaline phosphatase (ALP) after surgery were not significant (P＞0.05 for both). One year after surgery, the serum tartrate resistant acid phosphatase (TRACP) levels of the patients decreased from 6.90 (4.69, 10.28) U/L to 2.50 (1.97, 3.13) U/L (P＜0.001); the serum C-terminal cross-linked peptide of collagen type I (CTX-I) levels decreased from 2.27(1.46, 3.05) μg/L before the operation to 0.36 (0.23, 0.96) μg/L (P＜0.001); serum procollagen type 1 aminoterminal propeptide (P1NP) levels decreased from 1062.00 (438.30, 1200.00) μg/L to 168.70 (116.30, 342.00) μg/L (P＜0.001); serum bone-specific alkaline phosphatase (BAP) levels decreased from 60.00 (33.36, 90.00) μg/L to 12.44 (10.95, 16.48) μg/L (P＜0.001); however, there was no significant change in serum N-terminal midfragment of osteocalcin (N-MID-OC) before and after operation (P=0.499). One year after surgery, the bone mineral density (BMD) of lumbar spine 1-4 (L1-4) increased from 1.02 g/cm2 to 1.14 g/cm2 (P=0.002); L1-4 T score increased from -0.76±1.70 to 0.28±1.70 (P＜0.001); the total hip BMD and T score increased significantly from 0.76 (0.67, 0.88) g/cm2 to 0.87 (0.76, 1.00) g/cm2, and from -1.70 (-2.40, -0.80) to -0.75 (-1.52, 0.20), respectively (P＜0.001 for both).Conclusion:Parathyroidectomy can improve bone metabolism and increase bone mineral density in patients with secondary hyperparathyroidism.
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