Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic p
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ORIGINAL ARTICLE
Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism Daichi Miyaoka 1 Yasuo Imanishi1 Eiko Kato1 Norikazu Toi1 Yuki Nagata1 Masafumi Kurajoh1 Shinsuke Yamada1 Masaaki Inaba1 Masanori Emoto1 ●
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Received: 15 April 2020 / Accepted: 24 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To evaluate the effects of denosumab (Dmb) on calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism (PHPT) and compare with those who underwent a parathyroidectomy (PTX) procedure. Methods This retrospective, longitudinal study included patients treated with Dmb (60 mg) once every 6 months (n = 19) and those who successfully underwent a PTX procedure (n = 19) corrected calcium (cCa), eGFR, bone mineral density (BMD) in the lumbar spine (LS), total hip (TH), and femoral neck (FN) and LS-trabecular bone score (TBS) changes at 1 year after beginning Dmb or undergoing PTX were measured. Results Dmb group had older age, and showed milder disease activity and lower eGFR as compared with PTX group. In PTX group, cCa and eGFR were significantly decreased following surgery, while those were stable in Dmb group. There were significant increases in LS, TH, and FN-BMD in both Dmb (LS: 6.0 ± 0.8%, TH: 3.7 ± 1.0%, FN: 4.3 ± 1.5%) and PTX (LS: 11.2 ± 1.5%, TH: 7.5 ± 1.5%, FN: 7.9 ± 2.1%) groups. In Dmb group, LS-TBS was significantly improved by 3.0 ± 1.0%, while TBS change in PTX group approached significance (2.8 ± 1.5%). Percent change in TH-BMD was significantly correlated with baseline tartrate-resistant acid phosphatase-5b (TRACP-5b) in both groups. Conclusions Dmb treatment not only increased BMD, dependent on bone turnover status, the same as PTX, but also improved LS-TBS. In addition, it did not decrease the level of eGFR, whereas PTX did. These results suggest that Dmb treatment help in the clinical management of osteoporotic patients with PHPT who do not undergo surgery as alternative to PTX. Keywords Primary hyperparathyroidism Denosumab Parathyroidectomy Osteoporosis Bone mineral density Trabecular bone score ●
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Introduction Primary hyperparathyroidism (PHPT), the third most frequent endocrine disorder, increases with age and is often diagnosed in patients without clinical symptoms [1]. A parathyroidectomy (PTX) procedure is the only definitive treatment, even for asymptomatic patients, and reduces the
* Daichi Miyaoka [email protected] 1
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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risk of kidney stones and fractures [2], though a progressive age-related decline in the rate of PTX procedures after the age of 70 years has been noted [3]. As for PHPT patients who cannot or refuse to undergo surgery, calcium, renal, and bone-protective strategies as an alternative to PTX are availab
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