Primary hyperparathyroidism: renal calcium excretion in patients with and without renal stone sisease before and after parathyroidectomy.

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Primary hyperparathyroidism: renal calcium excretion in patients with and without renal stone sisease before and after parathyroidectomy.
World J Surg. 2002 May;26(5):532-5
Authors: Frøkjaer VG, Mollerup CL
Abstract
The effect of parathyroidectomy on renal calcium excretion per 24 hours in patients with primary hyperparathyroidism with and without a history of renal stone disease was evaluated. Altogether, 91 patients operated on for primary hyperparathyroidism formed the study group for preoperative analysis. Of these patients, 42 were evaluated 1 to 3 years postoperatively. The median preoperative serum calcium level was 2.92 mmol/L, and it was the same for patients with or without renal stones. Preoperatively we found no differences in renal calcium excretion between patients with and without renal stone disease. The median renal calcium excretion was 6.80 mmol/24 hr. At 1 to 3 years after successful parathyroidectomy the group with renal stone disease had higher renal calcium excretion than the group without renal stones (p = 0.03). The reduced effect of parathyroidectomy on renal calcium excretion in the patients with renal stone disease indicates that factors not related to the hyperparathyroid state could contribute to disturbances in renal calcium excretion and hence stone formation. In conclusion, the pathologic basis for renal stone formation in patients with primary hyperparathyroidism might not be the hyperparathyroid state alone; stone formation could be related to other predisposing factors as well. Therefore, although parathyroidectomy can cure hyperparathyroidism, the curative effect on renal stone disease should be reconsidered.
PMID: 12098039 [PubMed – indexed for MEDLINE]
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[Cohort study of fracture risk before and after surgery of primary hyperparathyroidism].

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[Cohort study of fracture risk before and after surgery of primary hyperparathyroidism].

Ugeskr Laeger. 2001 Sep 3;163(36):4875-8

Authors: Vestergaard P, Mollerup CL, Frøkjaer VG, Christiansen PM, Blichert-Toft M, Mosekilde L

Abstract
We studied the risk of fracture in 674 patients operated on for primary hyperparathyroidism compared to 2,021 age- and gender-matched controls, matched for age and gender, randomly drawn from the background population. Before surgery, there was an increased risk of fracture (relative risk 1.8, 9% confidence interval 1.3-2.3), but after surgery the relative risk was normalised (RR = 1.0, 0.8-1.3). The increased risk began ten years before surgery and peaked five to six years before surgery. After surgery, there was a temporary increase in the first year, but in the following years the fracture risk was normalised, with a small rise in distal forearm fractures more than ten years after surgery. Primary hyperparathyroidism may have started up to ten years before surgery, and the fracture risk is normalised after surgery.

PMID: 11571864 [PubMed – indexed for MEDLINE]

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Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism.

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Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism.
BMJ. 2000 Sep 9;321(7261):598-602
Authors: Vestergaard P, Mollerup CL, Frøkjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L
Abstract
OBJECTIVES: To study whether fracture risk before and after surgery was increased in patients with primary hyperparathyroidism.
DESIGN: Cohort study.
SETTING: Three Danish university hospitals.
PARTICIPANTS: 674 consecutive patients with primary hyperparathyroidism (median age 61, range 13-89 years) operated on during the period 1 January 1979 to 31 December 1997; 2021 age and sex matched controls from national patient register.
MAIN OUTCOME MEASURE: Fractures.
RESULTS: The cases had an increased relative rate of fractures compared with the controls before surgery (1.8, 95% confidence interval 1.3 to 2.3) but not after surgery (1.0, 0.8 to 1.3). The risk of fracture was increased for the vertebrae (3.5, 1.3 to 9.7), the distal part of the lower leg and ankles (2.3, 1.2 to 4.3), and the non-distal part of the forearm (4.0, 1.5 to 10.6) before surgery but not after. The increase in risk of fracture began about 10 years before surgery. Risk peaked 5-6 years before surgery and remained raised, although at a lower level, in the five years immediately before surgery. A small increase in risk of fracture of the distal forearm emerged more than 10 years after surgery (2.9, 1. 3 to 6.7).
CONCLUSIONS: Risk of fracture is increased up to 10 years before surgery in patients with primary hyperparathyroidism. The risk returns to normal after surgery.
PMID: 10977834 [PubMed – indexed for MEDLINE]
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