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Osteoporosis in Multiple Endocrine Neoplasia Type 1: Severity, Clinical Significance, Relationship to Primary Hyperparathyroidism, and Response to Parathyroidectomy
Citation
Burgess, JR and David, R and Greenaway, TM and Parameswaran, V and Shepherd, JJ, Osteoporosis in Multiple Endocrine Neoplasia Type 1: Severity, Clinical Significance, Relationship to Primary Hyperparathyroidism, and Response to Parathyroidectomy, Archives of Surgery, 134, (10) pp. 1119-1123. ISSN 0004-0010 (1999) [Refereed Article]
DOI: doi:10.1001/archsurg.134.10.1119
Abstract
Background: Sporadic primary hyperparathyroidism (PHPT) occurs most frequently in postmenopausal women. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal-dominant disease in which mild to moderate PHPT develops in most gene carriers by 20 years of age. Primary hyperparathyroidism associated with MEN I is typically recurrent, despite initially successful subtotal parathyroidectomy. Osteoporosis is considered a complication of sporadic PHPT and an indication for parathyroidectomy. In the setting of MEN 1, however, the relationship of bone mass to PHPT, fracture risk, and parathyroidectomy is unknown. Hypothesis: Parathyroidectomy improves bone mineral density for patients with primary hyperparathyroidism in the setting of MEN 1. Design: Case series. Setting: Tertiary referral center. Patients: Twenty-nine women with MEN 1 belonging to a single family with a history of MEN 1. Interventions: Parathyroidectomy. Main Outcome Measures: Bone mineral density (BMD) and history of skeletal fracture. Results: Osteopenia and osteoporosis were diagnosed in 41% and 45% of patients, respectively. Forty- four percent of patients with uncontrolled PHPT had severe osteopenia (T score, <-2.0) by 35 years of age. Reduction in BMD was greatest at the femoral neck. Reduced BMD was associated with an increased likelihood of skeletal fracture (P = .05). Patients with uncontrolled PHPT had lower femoral neck and lumbar spine BMDs than those in whom PHPT was controlled by parathyroidectomy (P = .005 and .02, respectively). Successful parathyroidectomy improved femoral neck and lumbar spine BMDs by a mean ± SEM of 5.2% ± 2.5% and 3.2% ± 2.9%, respectively. Conclusions: Osteoporosis is a frequent and early complication of PHPT in MEN 1. Despite difficulty in achieving a cure of PHPT in MEN 1, parathyroidectomy has an important role in the optimization of BMD for patients with MEN 1.
Item Details
Item Type: | Refereed Article |
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Research Division: | Biomedical and Clinical Sciences |
Research Group: | Clinical sciences |
Research Field: | Endocrinology |
Objective Division: | Health |
Objective Group: | Clinical health |
Objective Field: | Clinical health not elsewhere classified |
UTAS Author: | Burgess, JR (Professor John Burgess) |
UTAS Author: | David, R (Mr Reuben David) |
UTAS Author: | Greenaway, TM (Dr Tim Greenaway) |
UTAS Author: | Parameswaran, V (Associate Professor Venkat Parameswaran) |
UTAS Author: | Shepherd, JJ (Professor Joseph Shepherd) |
ID Code: | 16050 |
Year Published: | 1999 |
Web of Science® Times Cited: | 72 |
Deposited By: | Medicine |
Deposited On: | 1999-08-01 |
Last Modified: | 2000-06-21 |
Downloads: | 0 |
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