Bone Disease and Primary Hyperparathyroidism

  • Bone disease, including:
    • Osteopenia, osteoporosis, and osteitis fibrosa cystica:
      • Is found in approximately 15% of patients with primary hyperparathyroidism at the time of diagnosis
    • Increased bone turnover:
      • As found in patients with osteitis fibrosa cystica:
        • Can be determined by documenting:
          • Elevated alkaline phosphatase concentration
    • Advanced PHPT with osteitis fibrosa cystica:
      • Now occurs in less than 5% of patients
    • The classic manifestation of PHPT bone disease is:
      • Osteitis fibrosa cystica:
        • Which is characterized clinically by bone pain and radiographically by subperiosteal bone resorption
      • It has pathognomonic radiological findings:
        • Which are best seen on radiographs of the hands:
          • And are characterized by subperiosteal resorption:
            • Most evident in the radial aspect of the middle phalanx of the second and third fingers
          • Bone cysts
          • Tuft formation of the upper part of the distal phalanges
        • Brown or osteoclastic tumors of the long bones:
          • Result from excess osteoclast activity:
            • And consist of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone
          • The brown coloration is due to:
            • Hemosiderin deposition
        • Tapering of the distal clavicle
      • Patients with normal serum alkaline phosphatase levels:
        • Rarely have clinically apparent osteitis fibrosa cystica
  • PHPT typically results in a loss of bone volume:
    • At the cortical bone sites such as:
      • The radius
    • Relative preservation of cancellous bone:
      • As found in vertebral bodies
      • Patients with primary hyperparathyroidism, however:
        • May also have osteoporosis in the lumbar spine that dramatically improves after parathyroidectomy
  • Fractures are also more common in patients with primary hyperparathyroidism, and the incidence of fractures:
    • Also decreases after parathyroidectomy:
      • Bone disease is correlated with serum PTH and vitamin D levels

#Arrangoiz #ParathyroidSurgeon #ParahthyroidExpert #Hyperparathyroidism #HeadandNeckSurgeon #EndocrineSurgery #CASO #XCenterforAdvancedSurgicalOncology

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