Hyperparathyroidism and bone mineral density in patients with chronic kidney disease: influence of parathyroidectomy

Aim: we analyzed changes of bone mineral density (BMD) in patients with chronic kidney disease (CKD) and severe hyperparathyroidism (НPT) in the preoperative period and after parathyroidectomy (PTХ). Methods: a single-center retrospective observational study included 44 dialysis patients with HPT. All patients underwent subtotal and total PTX. BMD in the distal forearm (1/3 Radius and Radius Total), proximal femur (Femoral Neck and Total Hip) and lumbar spine (L1-L4) was determined by dual energy X-ray absorptiometry (DRA). The absolute value of the BMD (g/cm2) and the Z- and T-scores (SD) were taken into account. The stability of the BMD was determined to be within ±2%. In total 137 DRA sessions were performed (in average once a year): 78 of them were performed in preoperative period and 59 of them after the PTX. The duration of the follow up was 1-4 years. Results: during a year before PTX the average loss of BMD was 7.6±2.3%, 11.1±4.6%, 10.5±8.9%, 9.9±8.7% and 6.0±6.8%, respectively in 1/3 Radius, Radius Total, Femoral Neck, Total Hip and L1-L4. The highest prevalence of osteopenic syndrome estimated by the Z- and T-scores was recorded in the distal forearm. BMD was markedly improved in all parts of skeleton averaging 8-9% in the distal forearm and proximal femur and 5% in L1-L4 (p=0.03 and p=0.05), after two years - 4-3% и 3% respectively. An inverse relationship was established between the percentage of BDM increase after PTX and its baseline before the PTX, for Femoral Neck (p=0.009) and Total Hip (p=0.049) and a tendency for it for 1/3 Radius (p=0.077). Conclusions: there is a high prevalence of osteopenic syndrome with predominant localization in cortical bones in patients with CKD. The dynamic increase in BMD deficiency can serve as an additional argument in favor of the need to implement the PTX. PTX leads to a significant increase in BMD and reduces the incidence of osteopenic syndrome.

хроническая болезнь почек, диализ, гиперпаратиреоз, паратиреоидэктомия, минеральная плотность кости, двухэнергетическая рентгеновская абсорбциометрия, chronic kidney disease, dialysis, hyperparathyroidism, parathyroidectomy, bone mineral density, dual energy X-ray absorptiometry

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