Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11721
Title: New insights into the effects of primary hyperparathyroidism on the cortical and trabecular compartments of bone.
Authors: Vu, Thuy D T;Wang, Xiao Fang;Wang, Qingju;Cusano, Natalie E;Irani, Dinaz;Silva, Barbara C;Ghasem-Zadeh, Ali;Udesky, Julia;Romano, Megan E;Zebaze, Roger M D;Jerums, George;Boutroy, Stephanie;Bilezikian, John P;Seeman, Ego
Affiliation: Department of Medicine and Endocrinology, Austin Health, University of Melbourne, Heidelberg, Australia. t.vu12@pgrad.unimelb.edu.au
Issue Date: 26-Mar-2013
Citation: Bone 2013; 55(1): 57-63
Abstract: In primary hyperparathyroidism (PHPT), protracted elevation of serum parathyroid hormone (PTH) is held to be associated with cortical, but not trabecular, bone loss. However, an alternative explanation for the apparent preservation of trabecular bone is fragmentation of the cortex by intracortical remodeling. The cortical fragments resemble trabeculae and so may be erroneously included in the quantification of 'trabecular' bone density. To test this hypothesis, we compared bone microarchitecture in 43 patients with untreated PHPT (mean 62.9 years, range 31-84) with 47 healthy age-matched controls and 25 patients with surgically treated PHPT (63.6 years, 30-82). Images of the distal radius and tibia were acquired using high-resolution peripheral quantitative CT and analysed using StrAx1.0, a new software program that quantifies bone morphology in-vivo. Results were expressed as the mean number of standardized deviations (SD) from the age-specific mean (Z scores, mean±SEM). In subjects with PHPT, total tibial cortical area was reduced -0.26±0.08 SD; p=0.002). Cortical volumetric bone mineral density (vBMD) was reduced (-0.29±0.06 SD; p<0.001) due to higher cortical porosity (0.32±0.06 SD; p<0.001) and lower tissue mineralization density (-0.21±0.06 SD; p=0.002). Medullary area was increased (0.26±0.08 SD; p=0.002) and trabecular vBMD was reduced (-0.14±0.04 SD; p<0.001). In subjects who underwent successful parathyroidectomy, cortical area (-0.18±0.10 SD; NS) and medullary area (0.18±0.10 SD; NS) did not differ from controls. Cortical vBMD was reduced (-0.15±0.05 SD; p=0.003) due to high porosity (0.15±0.05 SD; p=0.006), values numerically lower than in untreated PHPT. Tissue mineralization density (-0.26±0.04 SD; p<0.001) and trabecular vBMD were reduced (-0.16±0.04 SD, p<0.001). The results were similar in the distal radius. In PHPT, chronically elevated endogenous PTH does not spare trabecular bone; it causes bone loss and microarchitectural deterioration in both cortical and trabecular compartments of bone.
Internal ID Number: 23541782
URI: http://ahro.austin.org.au/austinjspui/handle/1/11721
DOI: 10.1016/j.bone.2013.03.009
URL: http://www.ncbi.nlm.nih.gov/pubmed/23541782
Type: Journal Article
Subjects: Adult
Aged
Aged, 80 and over
Bone Density
Bone and Bones.pathology.radiography
Case-Control Studies
Female
Humans
Hyperparathyroidism, Primary.drug therapy.pathology.radiography
Male
Middle Aged
Radius.pathology.radiography
Tibia.pathology.radiography
Tomography, X-Ray Computed
Appears in Collections:Journal articles

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