Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women
Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women
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DOI：
10.1210/jc.2005-2102
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发表时间：
2006-05-01
影响因子：
5.8
通讯作者：
Lyritis, GP
中科院分区：
文献类型：
--
作者：
Charopoulos, I;Tournis, S;Lyritis, GP
背景：原发性甲状旁腺功能亢进（PH）的特征是PTH不适当升高伴或不伴高钙血症。骨疾病涉及皮质部位的分解代谢作用，而松质骨部位和几何形状可能相对保留。目的：我们的目的是使用绝经后PH妇女和健康对照者胫骨外周定量计算机断层扫描检查PH对定量和定性骨特征的影响。设计和设置：我们在三级转诊中心进行了一项横断面研究。患者：52名绝经后PH妇女和56名健康对照者参加了研究，年龄和人体测量指标相当。干预：没有干预。主要结果测量：我们评估了体积骨矿物质密度（vBMD）、骨矿物质含量（BMC）、皮质厚度、皮质和小梁面积、骨周和骨内膜周长，左侧胫骨外周定量计算机断层扫描评估的极性应力强度指数为4%（松质骨），14%（过渡区）和38%结果：在4%时，骨小梁BMC和vBMD显著降低（P < 0.001），在高钙血症患者中效果尤其明显，而骨小梁面积相当。在38%时，PH组皮质BMC（P <0.01）、vBMD（P < 0.01）、面积（P < 0.05）和厚度（P < 0.001）降低，特别是在高钙血症患者中。骨内膜周长增加（P < 0.001），而骨膜周长相当，表明松质骨。在14%，极性应力强度指数显着降低（P < 0.01）在高钙患者，表明损害骨mechanical properties.Conclusions：normocalyptophenol PH的特点是在皮质和松质骨网站（38和4%，分别），效果加重高钙患者的分解作用。皮质几何特性受到不利影响，即使在正常的calmocalcium患者，而骨小梁的性质一般被保留。
Context: Primary hyperparathyroidism (PH) is characterized by inappropriate PTH elevation with or without hypercalcemia. Bone disease involves catabolic action at cortical sites, whereas cancellous sites and geometry might be relatively preserved.Objective: Our objective was to examine the effect of PH on quantitative and qualitative bone characteristics using peripheral quantitative computed tomography at the tibia in postmenopausal women with PH and healthy controls.Design and Setting: We conducted a cross-sectional study at a tertiary referral center.Patients: Fifty-two postmenopausal women with PH and 56 healthy controls, comparable for age and anthropometric measures, participated.Intervention: There was no intervention.Main Outcome Measure: We assessed volumetric bone mineral density (vBMD), bone mineral content (BMC), cortical thickness, cortical and trabecular area, peri- and endosteal circumference, and polar stress strength index assessed by peripheral quantitative computed tomography of the left tibia at 4% (cancellous), 14% (transition zone), and 38% (cortical) from the distal end.Results: At 4%, there was a significant decrease of trabecular BMC and vBMD (P < 0.001), effect particularly evident in hypercalcemic patients, whereas trabecular area was comparable. At 38%, cortical BMC (P < 0.01), vBMD (P < 0.01), area (P < 0.05), and thickness (P < 0.001) were reduced in the PH group, particularly in hypercalcemic patients. Endosteal circumference increased (P < 0.001), whereas periosteal circumference was comparable, indicating cancellization of cortical bone. At 14%, polar stress strength index was significantly decreased (P < 0.01) in hypercalcemic patients, indicating impairment of bone mechanical properties.Conclusions: Normocalcemic PH is characterized by catabolic actions at both cortical and cancellous sites (38 and 4%, respectively), an effect accentuated in hypercalcemic patients. Cortical geometric properties are adversely affected even in normocalcemic patients, whereas trabecular properties are generally preserved.