Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease

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Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease. / Valdemarsson, S; Lindergård, B; Tibblin, Sten; Bergenfelz, A.

In: Journal of Internal Medicine, Vol. 243, No. 2, 02.1998, p. 115-22.

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T1 - Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease

AU - Valdemarsson, S

AU - Lindergård, B

AU - Tibblin, Sten

AU - Bergenfelz, A

PY - 1998/2

Y1 - 1998/2

N2 - OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.INTERVENTION: All patients were operated upon and restudied one year later.MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA).RESULTS: Bone formation markers consistently decreased after parathyroid surgery: ALP from 3.51 +/- 0.23 to 2.94 +/- 0.21 microkat L(-1) (P < 0.05), osteocalcin from 6.15 +/- 0.53 to 2.89 +/- 0.23 microg L(-1) (P < 0.001) and PICP from 126.4 +/- 10.9 to 96.0 +/- 6.5 microg L(-1) (P < 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 +/- 0.54 to 3.94 +/- 0.34 microg L(-1) (P < 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25-dihydroxy-vitamin D concentrations.CONCLUSIONS: pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.

AB - OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.INTERVENTION: All patients were operated upon and restudied one year later.MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA).RESULTS: Bone formation markers consistently decreased after parathyroid surgery: ALP from 3.51 +/- 0.23 to 2.94 +/- 0.21 microkat L(-1) (P < 0.05), osteocalcin from 6.15 +/- 0.53 to 2.89 +/- 0.23 microg L(-1) (P < 0.001) and PICP from 126.4 +/- 10.9 to 96.0 +/- 6.5 microg L(-1) (P < 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 +/- 0.54 to 3.94 +/- 0.34 microg L(-1) (P < 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25-dihydroxy-vitamin D concentrations.CONCLUSIONS: pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.

KW - Absorptiometry, Photon

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bone Density

KW - Bone Remodeling

KW - Bone Resorption

KW - Calcium

KW - Creatinine

KW - Female

KW - Humans

KW - Hyperparathyroidism

KW - Kidney

KW - Male

KW - Middle Aged

KW - Parathyroid Hormone

KW - Phosphates

KW - Radionuclide Imaging

KW - Radius

KW - Severity of Illness Index

KW - Vitamin D

KW - Journal Article

U2 - 10.1046/j.1365-2796.1998.00241.x

DO - 10.1046/j.1365-2796.1998.00241.x

M3 - Article

VL - 243

SP - 115

EP - 122

JO - Journal of Internal Medicine

JF - Journal of Internal Medicine

SN - 1365-2796

IS - 2

ER -