 |
 |
|
|
|  PubMed
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 September 1996 | Volume 125 Issue 5 | Pages 360-368
Background: Most patients with primary hyperparathyroidism are postmenopausal women. The presence of osteopenia in persons with mild primary hyperparathyroidism is considered an indication for parathyroidectomy. No prospective, controlled trials have assessed medical therapies for osteopenia in primary hyperparathyroidism.
Objective: To examine the effects of estrogen-progestin therapy (hormone replacement therapy) on bone mineral density and biochemical indices in postmenopausal women with mild primary hyperparathyroidism.
Design: Double-blind, randomized, placebo-controlled trial.
Setting: University teaching hospital.
Patients: 42 postmenopausal women with mild primary hyperparathyroidism.
Intervention: Patients were randomly assigned to receive either conjugated estrogens, 0.625 mg/d, and medroxyprogesterone, 5 mg/d, or placebo.
Measurements: Bone mineral densities of the total body, lumbar spine, proximal femur (femoral neck, Ward triangle, trochanter), and proximal forearm were measured every 6 months using dual-energy x-ray absorptiometry. Biochemical indices of bone turnover and calcium metabolism were measured at baseline, 6 months, and 2 years.
Results: In the placebo group, bone mineral densities of the total body and the proximal forearm decreased significantly from baseline (mean ± SE, –2.3%± 0.7% [P = 0.005] and –3.5%± 1.2% [P = 0.01], respectively). At the other sites, bone mineral density also tended to decline. In the hormone replacement therapy group, bone mineral density increased from baseline in the total body (1.3% ± 0.4%; P = 0.004), lumbar spine (5.2% ± 1.4%; P = 0.002), and femoral neck (3.4% ± 1.5%; P = 0.05). The between-group differences in bone mineral density at the end of the study ranged from 3.6% to 6.6% and were significant at all sites (P > 0.001 and P < 0.05) except for the Ward triangle (P = 0.06). In the hormone replacement therapy group, serum alkaline phosphatase levels decreased by 22% (P = 0.0004 compared with baseline), urinary hydroxyproline excretion decreased by 42% (P = 0.0004), urinary N-telopeptide excretion decreased by 54% (P = 0.001), and urinary calcium excretion decreased by 45% (P = 0.007). Hormone replacement therapy did not change levels of serum ionized calcium or intact parathyroid hormone.
Conclusions: Although hormone replacement therapy has little effect on serum calcium levels, it suppresses bone turnover, reduces urinary calcium excretion, and increases bone mineral density throughout the skeleton in postmenopausal women with mild primary hyperparathyroidism. This therapy is thus an important management option for these patients.
Author and Article Information
From the University of Auckland, Auckland, New Zealand, and Yale University, New Haven, Connecticut.
ARTICLE
Effect of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women with Mild Primary Hyperparathyroidism
A Randomized, Controlled Trial
Grant Support: By the Auckland Medical Research Foundation, the Health Research Council of New Zealand, and the New Zealand Lotteries Board.
Acknowledgment: The authors thank Greg Gamble for statistical advice.
Requests for Reprints: Ian Reid, MD, Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1, New Zealand.
Current Author Addresses: Drs. Reid and Tatnell, Ms. Evans, and Ms. Stapleton: Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1, New Zealand.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  A. Khan, A. Grey, and D. Shoback Medical Management of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 373 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Iglesias and J J Diez Current treatments in the management of patients with primary hyperparathyroidism Postgrad. Med. J., January 1, 2009; 85(999): 15 - 23. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Wysolmerski Conversations Between Breast and Bone: Physiological Bone Loss During Lactation as Evolutionary Template for Osteolysis in Breast Cancer and Pathological Bone Loss After Menopause IBMS BoneKEy, August 1, 2007; 4(8): 209 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Strewler A 64-Year-Old Woman With Primary Hyperparathyroidism JAMA, April 13, 2005; 293(14): 1772 - 1779. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Rao, E. R. Phillips, G. W. Divine, and G. B. Talpos Randomized Controlled Clinical Trial of Surgery Versus No Surgery in Patients with Mild Asymptomatic Primary Hyperparathyroidism J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5415 - 5422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Khan, J. P. Bilezikian, A. W. C. Kung, M. M. Ahmed, S. J. Dubois, A. Y. Y. Ho, D. Schussheim, M. R. Rubin, A. M. Shaikh, S. J. Silverberg, et al. Alendronate in Primary Hyperparathyroidism: A Double-Blind, Randomized, Placebo-Controlled Trial J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3319 - 3325. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Bilezikian and S. J. Silverberg Asymptomatic Primary Hyperparathyroidism N. Engl. J. Med., April 22, 2004; 350(17): 1746 - 1751. [Full Text] [PDF]
|
|
|
|
|
|
M. R. Rubin, K. H. Lee, D. J. McMahon, and S. J. Silverberg Raloxifene Lowers Serum Calcium and Markers of Bone Turnover in Postmenopausal Women with Primary Hyperparathyroidism J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1174 - 1178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Chow, W. B. Chan, J. K. Y. Li, N. N. Chan, M. H. M. Chan, G. T. C. Ko, K. W. Lo, and C. S. Cockram Oral Alendronate Increases Bone Mineral Density in Postmenopausal Women with Primary Hyperparathyroidism J. Clin. Endocrinol. Metab., February 1, 2003; 88(2): 581 - 587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Jelinsky, H. A. Harris, E. L. Brown, K. Flanagan, X. Zhang, C. Tunkey, K. Lai, M. V. Lane, D. K. Simcoe, and M. J. Evans Global Transcription Profiling of Estrogen Activity: Estrogen Receptor {alpha} Regulates Gene Expression in the Kidney Endocrinology, February 1, 2003; 144(2): 701 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. A. Nakchbandi, M. A. Mitnick, R. Lang, C. Gundberg, B. Kinder, and K. Insogna Circulating Levels of Interleukin-6 Soluble Receptor Predict Rates of Bone Loss in Patients with Primary Hyperparathyroidism J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4946 - 4951. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. S. Masiukiewicz, M. Mitnick, B. I. Gulanski, and K. L. Insogna Evidence that the IL-6/IL-6 Soluble Receptor Cytokine System Plays a Role in the Increased Skeletal Sensitivity to PTH in Estrogen-Deficient Women J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2892 - 2898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Marx Hyperparathyroid and Hypoparathyroid Disorders N. Engl. J. Med., December 21, 2000; 343(25): 1863 - 1875. [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Orr-Walker, M. C. Evans, J. M. Clearwater, A. Horne, A. B. Grey, and I. R. Reid Effects of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women With Primary Hyperparathyroidism: Four-Year Follow-up and Comparison With Healthy Postmenopausal Women Arch Intern Med, July 24, 2000; 160(14): 2161 - 2166. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Khan and J. Bilezikian Primary hyperparathyroidism: pathophysiology and impact on bone Can. Med. Assoc. J., July 1, 2000; 163(2): 184 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Utiger Treatment of Primary Hyperparathyroidism N. Engl. J. Med., October 21, 1999; 341(17): 1301 - 1302. [Full Text]
|
|
|
|
|
|
J. S. Finkelstein and D. A. Schoenfeld Effects of Gonadal Suppression on the Regulation of Parathyroid Hormone and 1,25-Dihydroxyvitamin D Secretion in Women J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 2151 - 2156. [Abstract] [Full Text]
|
|
|
|
|
|
S. J. Silverberg, H. G. Bone, T. B. Marriott, F. G. Locker, S. Thys-Jacobs, G. Dziem, S. Kaatz, E. L. Sanguinetti, and J. P. Bilezikian Short-Term Inhibition of Parathyroid Hormone Secretion by a Calcium-Receptor Agonist in Patients with Primary Hyperparathyroidism N. Engl. J. Med., November 20, 1997; 337(21): 1506 - 1511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 HRT in Postmenopausal Women with Mild Hyperparathyroidism Journal Watch Psychiatry, November 1, 1996; 1996(1101): 20 - 20. [Full Text]
|
|
|
|
 |
|
 HRT in Postmenopausal Women with Mild Hyperparathyroidism Journal Watch Women's Health, October 1, 1996; 1996(1001): 12 - 12. [Full Text]
|
|
|
|
 |
|
 HRT IN POSTMENOPAUSAL WOMEN WITH MILD HYPERPARATHYROIDISM Journal Watch (General), September 17, 1996; 1996(917): 5 - 5. [Full Text]
|
|
