Skeletal disease in primary hyperparathyroidism

Authors

  • Shonni J. Silverberg,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Elizabeth Shane,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Luz de la Cruz,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • David W. Dempster,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Frieda Feldman,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • David Seldin,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Thomas P. Jacobs,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Ethel S. Siris,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Maureen Cafferty,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • May V. Parisien,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Robert Lindsay,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Thomas L. Clemens,

    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
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  • Dr. John P. Bilezikian

    Corresponding author
    1. Departments of Medicine, Neurology, Pathology, Pharmacology, and Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
    2. Helen Hayes Hospital, West Haverstraw, NY
    • Department of Medicine 9–410 College of Physicians and Surgeons 630 W. 168th Street New York, NY 10032
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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.

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