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Review
. 2014 Jul;58(5):553-61.
doi: 10.1590/0004-2730000003381.

Bone disease in primary hyperparathyroidism

Francisco Bandeira  1 , Natalie E Cusano  2 , Barbara C Silva  3 , Sara Cassibba  4 , Clarissa Beatriz Almeida  1 , Vanessa Caroline Costa Machado  1 , John P Bilezikian  2
Affiliations
Review

Bone disease in primary hyperparathyroidism

Francisco Bandeira et al. Arq Bras Endocrinol Metabol. 2014 Jul.

Abstract

Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.

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Figures

Figure 1
Figure 1
Plain X-Ray shown “salt-and-pepper” appearance of the skull in a 38 years old female patient OFC.
Figure 2
Figure 2
Subperiosteal bone erosions on phalanges of the same patient from figure 1.
Figure 3
Figure 3
Fifty-seven years old with female with osteitis fibrosa cystica showing huge osteoclastomas in the femurs bilaterally.
Figure 4
Figure 4
Changes in serum calcium in a patient with severe PHPT who underwent treatment with alendronate 140 mg/week for 6 weeks prior to parathyroidectomy.
Figure 5
Figure 5
Changes in serum PTH in the same patient of figure 2, showing sharp decrease immediately after parathyroidectomy.
Figure 6
Figure 6
Long-term changes in bone mineral density in the same patient. Note the continuous gain in bone density up to seven years of follow-up.
See this image and copyright information in PMC

References

    1. Bandeira F, Griz L, Caldas G, Bandeira C, Freese E. From mild to severe primary hyperparathyroidism: the Brazilian experience. Arq Bras Endocrinol Metabol. 2006;50(4):657–63. - PubMed
    1. Kulak CA, Bandeira C, Voss D, Sobieszczyk SM, Silverberg SJ, Bandeira F, et al. Marked improvement in bone mass after parathyroidectomy in osteitis fibrosa cystica. J Clin Endocrinol Metab. 1998;83(3):732–5. - PubMed
    1. Silverberg SJ, Clarke B, Peacock M, et al. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metabol. 2014 In press. - PMC - PubMed
    1. Zhao L, Liu JM, He XY, Zhao HY, Sun LH, Tao B, et al. The changing clinical patterns of primary hyperparathyroidism in Chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab. 2013;98(2):721–8. - PubMed
    1. Oliveira UE, Ohe MN, Santos RO, Cervantes O, Abrahão M, Lazaretti-Castro M, et al. Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism. Braz J Med Biol Res. 2007;40(4):519–26. - PubMed

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