Primary hyperparathyroidism and the skeleton.

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Abstract

[Indexed for MEDLINE] 11. Rev Endocr Metab Disord. 2021 Dec;22(4):789-802. doi: 10.1007/s11154-020-09614-0. Epub 2020 Nov 16. Skeletal abnormalities in Hypoparathyroidism and in Primary Hyperparathyroidism. Silva BC(1)(2)(3), Bilezikian JP(4). Author information: (1)Department of Medicine, Centro Universitario de Belo Horizonte - UNI BH, Belo Horizonte, Brazil. (2)Endocrinology Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil. (3)Endocrinology Unit, Santa Casa Hospital, Belo Horizonte, Brazil. (4)Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 8E: 105G, New York, NY, 10032, USA. jpb2@columbia.edu. Both hypoparathyroidism (HypoPT), as well as its pathological counterpart, primary hyperparathyroidism (PHPT), can lead to skeletal abnormalities. Chronic deficiency of PTH in patients with HypoPT is associated with a profound reduction in bone remodeling, with consequent increases in bone density, and abnormalities in microarchitecture and bone strength. It is still not clear whether there is an increase in fracture risk in HypoPT. While standard therapy with calcium supplements and active vitamin D does not restore bone homeostasis, treatment of HypoPT with PTH appears to correct some of those abnormalities. In PHPT, the continuous exposure to high levels of PTH causes an increase in bone remodeling, in which bone resorption prevails. In the symptomatic form of PHPT, patients can present with fragility fractures, and/or the classical radiological features of osteitis fibrosa cystica. However, even in mild PHPT, catabolic skeletal actions of PTH are evident through reduced BMD, deterioration of bone microarchitecture and increased risk of fragility fractures. Successful parathyroidectomy improves skeletal abnormalities. Medical treatment, such as bisphosphonates and denosumab, can also increase bone density in patients with PHPT who do not undergo surgery. This article reviews skeletal involvement in HypoPT and in PHPT, as assessed by bone remodeling, DXA, trabecular bone score, and quantitative computed tomography, as well as data on bone strength and fracture risk. The effects of PTH replacement on the skeleton in subjects with HypoPT, and the outcome of parathyroidectomy in patients with PHPT, are also reviewed here. © 2020. Springer Science+Business Media, LLC, part of Springer Nature. DOI: 10.1007/s11154-020-09614-0