Effectiveness of anti-osteoporotic treatment after successful parathyroidectomy for primary hyperparathyroidism: a randomized, double-blind, placebo-controlled trial

Martin B Niederle, Ursula Foeger-Samwald, Philipp Riss, Andreas Selberherr, Christian Scheuba, Peter Pietschmann, Bruno Niederle, Katharina Kerschan-Schindl

Research output: Journal article (peer-reviewed)Journal article

4 Citations (Scopus)

Abstract

Purpose: After successful surgery for primary hyperparathyroidism, bone mineral density (BMD) does not improve equally in all patients. As no trial has so far aimed to influence normalization of BMD, it was the goal of this investigation to determine whether pharmacological treatment is effective in improving regain of BMD after successful parathyroidectomy in patients with preoperatively diagnosed osteoporosis or osteopenia and to evaluate when treatment may be indicated. Methods: In this randomized, placebo-controlled, double-blind trial, 52 patients were treated with strontium ranelate 2 g daily + 1000 mg calcium + 800 IU vitamin D (strontium group; SG) or with 1000 mg calcium + 800 IU vitamin D alone (placebo group; PG) for 1 year. The main outcome measures were BMD (lumbar spine, femoral neck, radius) and bone turnover markers. Results: The baseline characteristics were similar in both groups. Absolute BMD (1.007 ± 0.197 vs. 0.897 ± 0.137 g/cm 2; p = 0.024) and both relative (9.94 vs. 3.94%; p < 0.001) and absolute (0.09 ± 0.06 vs. 0.03 ± 0.04 g/cm 2; p < 0.001) changes in lumbar-spine BMD were significantly higher in the SG than in the PG. Compared to baseline, BMD significantly increased in both groups at the lumbar spine (p < 0.001 and p = 0.001, respectively) and femoral neck (both p < 0.001), whereas radius BMD only changed significantly in the SG. However, the proportion of patients with osteoporosis/osteopenia significantly declined only at the lumbar spine in the SG (from 69.0 to 37.9%; p = 0.034), whereas no decrease was found in the PG. No severe adverse events occurred. Conclusions: Postoperative anti-osteoporotic treatment can positively influence regain of BMD mainly in the lumbar spine and should be considered. Without treatment, most patients and especially those with low preoperative markers of bone turnover remained osteoporotic/osteopenic 1 year after surgery.

Original languageEnglish
Pages (from-to)681-691
Number of pages11
JournalLangenbeck's Archives of Surgery
Volume404
Issue number6
DOIs
Publication statusPublished - 01 Sept 2019
Externally publishedYes

Keywords

  • Bone Density/drug effects
  • Bone Diseases, Metabolic/drug therapy
  • Bone Remodeling
  • Calcium/therapeutic use
  • Double-Blind Method
  • Female
  • Humans
  • Hyperparathyroidism, Primary/complications
  • Male
  • Middle Aged
  • Osteoporosis/drug therapy
  • Parathyroidectomy
  • Thiophenes/therapeutic use
  • Vitamin D/therapeutic use
  • Osteoporosis
  • Biomarkers
  • Primary hyperparathyroidism
  • Bone mineral density

ASJC Scopus subject areas

  • Surgery

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