Skeletal abnormalities in Hypoparathyroidism and in Primary Hyperparathyroidism.
Fracture risk
Hypoparathyroidism
Osteoporosis
PTH(1–84)
Parathyroidectomy
Primary hyperparathyroidism
Journal
Reviews in endocrine & metabolic disorders
ISSN: 1573-2606
Titre abrégé: Rev Endocr Metab Disord
Pays: Germany
ID NLM: 100940588
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
accepted:
11
11
2020
pubmed:
18
11
2020
medline:
15
3
2022
entrez:
17
11
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33200346
doi: 10.1007/s11154-020-09614-0
pii: 10.1007/s11154-020-09614-0
doi:
Substances chimiques
Parathyroid Hormone
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
789-802Subventions
Organisme : NIH HHS
ID : NIH DK32333
Pays : United States
Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
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