RESULTS AND EFFECTIVENESS PREDICTORS OF ALENDRONATETHERAPY IN POSTMENOPAUSAL PATIENTS WITH PRIMARYHYPERPARATHYROIDISM

Primary hyperparathyroidism (PHPT) is a common disorder often associated with reduced bone mineral density (BMD) and osteoporosis. The main goal in treating patients who refuse surgery is the correction of bone complications.
The aim of this study is to evaluate safety and efficacy of alendronate treatment in patients with PHPT and osteoporosis. Eligible patients were postmenopausal women suffering from PHPT who did not meet surgical guidelines or ignored surgery due to different reasons. 55 osteoporotic or osteopenic women received alendronate 70 mg weekly and 43 were leaved under medical observation for the reasons of not being osteoporotic or financial unable to comply with treatment/
Results: After 2 years of treatment alendronate group showed statistically significant gain in BMD at L24 +4,0±4,2%, Neck +2,2±4,4%„ TH +2,3±4,5%. At the same time observational group showed decrease in BMD at L24 -4,2±4,0%, TH -3,5±3,8%, R33% -4,0±6,5%, [95% CI -7,6; -0,4]. On the whole BMD dynamics in groups differed at the following sites: L2 (p=0,00004), Neck (p=0,005), TH (p=0,001), R33% (p=0,006). '
Alendronate intake was accompanied by serum Ca decrease (at 1 year point -4,3±5,4%, p=0,00005, at 2 year -2,7±6,4%, p=0,04), 24 hours'Ca excretion decrease from (Me) 8,5 to 6,3 mmol/day at 1 year point, (p=0,007) without PTH elevation. As well as CTx fell at Me: 66% at 1 year and at 60% at 2 year point and OK at 39% and at 27%, correspondingly, p<0,01. In the observation group PTH, serum Ca were stable, 24 hours 'Ca excretion increased from 7,0 to 7,7 at 2 year, p=0,003, as well as CTx level that increased 53%, p=0,01 at 2 years.
Conclusions: alendronate treatment in postmenopausal women improves BMD in trabecular bone sites and prevents BMD decrease in cortical sites. At least 2 years of therapy is needed to get the significant increase BMD in cortical bone . All patients should be under medical control for timely revelation of disease progression.

Primary hyperparatyreodism, osteoporosis, alendronate, postmenopausal

1. Дубровина Я.А., Рожинская Л.Я., Мокрышева Н.Г. с соавт. Динамика минеральной плотности кости (МПК) после хирургического лечения первичного гиперпаратиреоза (ПГПТ) // тезисы докладов III Российского конгресса по остеопорозу -2008 -стр.119-120.

2. AACE/AAES position statement on the diagnosis and management of primary hyperparathyroidism // Endocr Pract. - 2005 - vol. 11 - pp. 49-54._

3. Adami S, Braga V, Squaranti R, et al. Bone measurements in asymptomatic primary hyperparathyroidism // Bone - 1998 - vol.22 - pp.565-70.

4. Ambrogini E, Cetani &lt;http://icem.endoiournals.org/cgi/content/&gt;full/92/8/3114-FN1 F, Cianferotti L, et al. Surgery or Surveillance for Mild Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized Clinical Trial // J Clin Endocrinol Metab - 2007 - 92(8) -pp. 3114-21.

5. Bollerslev J, Jansson S, Mollerup CL, et al. Medical observation compared to parathyroidectomy for asymptomatic primary hyperparathyroidism: a prospective, randomized trial // J Clin Endocrinol Metab -2007 -92(5) -pp.1687-92.

6. Chow CC, Chan WB, Li JK, et al. Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism // J Clin.Endocrinol.Metab - 2003 - vol. 88 -pp.581-7.

7. Garnero P. Markers of bone turnover for the prediction of fracture risk// Osteoporos. Int. -2000 - 11(6) - pp. S55-65.

8. De Geronimo S, Romagnoli E, Diacinti D, etal. The risk of fractures in postmenopausal women with primary hyperparathyroidism// European Journal of Endocrinology - 2006 - 155(3) - pp. 415-20.

9. Gianotti L, Tassone F, Cesario F, et al. A Slight Decrease in Renal Function Further Impairs Bone Mineral Density in Primary Hyperparathyroidism. The Journal of Clinical Endocrinology &amp; Metabolism - 2006 - 91(8) - pp. 3011-6.

10. Khan A, Bilezikian J. Primary hyperparathyroidism: pathophysiology and impact on bone // CMAJ - 2000 - 163 (2) -pp.184-7.

11. Khan A, Bilezikian J, Kung A, et al. Alendronate in Primary Hyperparathyroidism: A Double-Blind, Randomized, Placebo-Controlled Trial // J Clin.Endocrinol. Metab -2004 -89(7) -pp.3319-25.

12. Liberman UA, Weiss SR, Broil J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group //N Engl J Med - 1995 - vol. 333 -pp. 1437-43.

13. Nakaoka D, Sugimoto T, Kobayashi T et al. Prediction of Bone Mass Change after Parathyroidectomy in Patients with Primary Hyperparathyroidism // J Clin.Endocrinol.Metab - 2000 - 85(5) -pp.1901-07.

14. Parfitt AM. Parathyroid hormone and periosteal bone expansion // J Bone Miner Res - 2002 - 17 - pp.1741-43.

15. Parker C, Blackwell P, Fairbairn K, Hosking DJ. Alendronate in the Treatment of Primary Hyperparathyroid-Related Osteoporosis: A 2-Year Study// J Clin.Endocrinol.Metab - 2002 - 87(10) -pp.4482-9.

16. Rao DS, Honasoge M, Divine GW, et. al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications // J Clin.Endocrinol.Metab - 2000 85-pp.1054-8.

17. Rao D, Phillips E, Divine G, B. Talpos G. Randomized Controlled Clinical Trial of Surgery Versus No Surgery in Patients with Mild Asymptomatic Primary Hyperparathyroidism // J Clin.Endocrinol. Metab - 2004 - 89(11) - pp. 5415-22.

18. Rossini M, Gatti D, IsaiaG, et. al. Effectsof oral alendronate inelderly patients with osteoporosis and mild primary hyperparathyroidism //J Bone Miner Res -2001 -16 -pp.113-9.

19. Rubin MR, Bilezikian JP, McMahon DJ, et. al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years// J Clin.Endocrinol.Metab - 2008 - 93 - pp. 3462-70.

20. Scholz DA, Purnell DC Asymptomatic primary hyperparathyroidism: 10-year prospective study // Mayo Clin Proc - 1981 - 56 (5) - pp.473^178.

21. Silverberg SJ, Gartenberg F, Jacobs TP, et. al. Longitudinal measurements of bone density and biochemical indices in untreated primary hyperparathyroidism // J Clin Endocrinol Metab -1995 -80 -pp.723-8.

22. Silverberg SJ, Shane E, Dempster DW, Bilezikian JP. The effects of vitamin D insufficiency in patients with primary hyperparathyroidism //American Journal of Medicine - 1999 - 107 -pp.561-567.

23. Silverberg SJ, Shane E, Jacobs TP, et. al. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery // N Engl J Med - 1999 - 341 - pp.1249-55.

24. Siminoski K,Jiang G, Adachi JD, et. al. Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures // Osteoporos. Int. - 2005 - №16(4) - pp. 403-10.

25. Vestergaard P, Mosekilde L. Parathyroid surgery is associated with a decreased risk of hip and upper arm fractures in primary hyperparathyroidism: a controlled cohort study// Journal of Internal Medicine - 2004 - 255 - pp.108-14.

26. YamashitaH,Noguchi S, Uchino S, et. al. Influence of renal function on clinico-pathological features of primary hyperparathyroidism // Eur J Endocrinol - 2003 - 148 - pp.597-602.