[Effect of preoperative bisphosphonate therapy on bone mineral density in patients with primary hyperparathyroidism one year after parathyroidectomy].

A P Pershina-Miliutina, A K Eremkina, I D Ozhimalov, А V Khairieva, A M Gorbacheva, S V Ronzhina, N G Mokrysheva
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Abstract

Background: The main treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTE), conservative therapy, including bisphosphonates, can be used for preoperative correction of hypercalcemia, as well as to improve bone tissue condition among individuals for whom surgery should be postponed or cannot be performed due to high perioperative risks. The question of the effect of bisphosphonates on bone tissue after surgery remains open.

Aim: To study the effect of preoperative bisphosphonate therapy on BMD parameters assessed in DXA and 3D-DXA in patients with PHPT one year after radical PTE.

Materials and methods: The study was conducted on the basis of the Department of pathology of the parathyroid glands and disorders of mineral metabolism of "Endocrinology Research Center" state-funded research facility of the Ministry of Health of the Russian Federation. The study included 50 patients (2 men, 48 women), divided into two groups depending on the presence or absence of preoperative bisphosphonate (BF) therapy. The methods of DXA and 3D-DXA using 3D-Shaper Medical software were used to evaluate BMD and bone microarchitectonics. The statistical analysis was performed using the R language and the Statistica v.13 package.

Results: At the time of the disease's manifestation, both groups were comparable in terms of the main indicators of calcium phosphorus metabolism, with the exception of the level of beta-crosslapse, which was higher in the group without preoperative BPh therapy (p<0,001). There were also no differences in the parameters of DXA and 3D-DXA. After surgery, both groups showed a comparable increase in BMD based on the results of DXA in the main parts of the skeleton and 3D-DXA in the femur. Changes at the level of the statistical trend were obtained for the 3D-DXA parameters, the final absolute values of which were slightly higher in the second group, including the thickness of the cortical layer in the femur as a whole and in the neck. When comparing the results of DXA before and after PTE in patients receiving BPh, statistically significant differences in absolute BMD values were obtained only in the lumbar spine (p<0,001).According to 3D-DXA data, statistically significant differences were found only in the volume of mineral density of the trabecular bone of the femur as a whole (p=0,001).When analyzing up to - in the second group, statistically significant differences in absolute BMD values were observed in the lumbar region (p<0,001), in the hip as a whole (p<0,001) and in its neck (p=0,001).According to 3D-DXA data, statistically significant differences were found in three of the eight analyzed indicators, the volume of mineral density of the trabecular bone of the femur as a whole and in the neck (p<0,001 for both), as well as the volume of mineral density of the cortical bone in the neck, (p=0,001).

Conclusion: The 3D-DXA method allows us to evaluate not only BMD, but also its microarchitectonics, which is important for predicting the risk of fractures in patients with PHPT. Studies have shown that preoperative BPh therapy can negatively affect the recovery of BMD after PTE, especially in cortical bone tissue. Further studies are needed to confirm these data and clarify the effect of CF on the postoperative course of PHPT.

[术前双膦酸盐治疗对甲状旁腺切除术后1年原发性甲状旁腺功能亢进症患者骨密度的影响]。
背景:原发性甲状旁腺功能亢进症(PHPT)的主要治疗方法是甲状旁腺切除术(PTE),保守治疗,包括双膦酸盐,可用于术前纠正高钙血症,以及改善因围手术期高风险而应推迟或不能进行手术的个体的骨组织状况。手术后双膦酸盐对骨组织的影响仍然是一个悬而未决的问题。目的:研究术前双膦酸盐治疗对根治性pte术后1年PHPT患者DXA和3D-DXA评估的BMD参数的影响。材料和方法:本研究由俄罗斯联邦卫生部“内分泌研究中心”国家资助研究机构甲状旁腺和矿物质代谢紊乱病理学系进行。该研究包括50例患者(2男,48女),根据术前是否使用双膦酸盐(BF)治疗分为两组。采用3D-Shaper Medical软件的DXA和3D-DXA方法评估骨密度和骨微结构。统计分析使用R语言和Statistica v.13软件包进行。结果:在疾病表现时,两组在钙磷代谢的主要指标上具有可比较性,但β -交联水平在术前未接受BPh治疗的组中较高(p< 0.001)。DXA和3D-DXA的参数也无差异。手术后,根据骨骼主要部位的DXA和股骨的3D-DXA结果,两组的骨密度都有相当的增加。3D-DXA参数在统计趋势水平上的变化,第二组的最终绝对值略高,包括股骨整体和颈部皮质层厚度。当比较BPh患者PTE前后的DXA结果时,只有腰椎的绝对BMD值有统计学意义(p< 0.001)。根据3D-DXA数据,仅在整个股骨小梁的矿物密度体积上发现有统计学意义(p= 0.001)。在第二组中,在腰椎区域(p< 0.001)、整个髋关节(p< 0.001)和颈部(p= 0.001)的绝对骨密度值上观察到统计学上的显著差异。根据3D-DXA数据,在分析的8个指标中,股骨小梁整体和颈部的矿物密度体积(p= 0.001)以及颈部皮质骨的矿物密度体积(p= 0.001)中有3个指标存在统计学差异,差异有统计学意义。结论:3D-DXA方法不仅可以评估骨密度,还可以评估其微结构,这对于预测PHPT患者的骨折风险具有重要意义。研究表明术前BPh治疗会对PTE后骨密度的恢复产生负面影响,尤其是皮质骨组织。需要进一步的研究来证实这些数据,并阐明CF对PHPT术后病程的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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