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Bone quality poor following parathyroidectomy in patients with obesity
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Adults with obesity and primary hyperparathyroidism who underwent parathyroidectomy experienced improvements in bone mineral density but had persistently lower trabecular bone score than lower-weight patients 2 years after surgery, study data show.
John P. Bilezikian, MD, of the division of endocrinology, department of medicine at Columbia University College of Physicians and Surgeons, and colleagues evaluated data on 30 adults (mean age, 62.9 years; 70% women) with primary hyperparathyroidism to determine the effect of obesity on trabecular bone score (TBS) and BMD at baseline and 2 years after parathyroidectomy.
Participants were divided into two groups based on BMI: at least 30 kg/m2 defined as obese (n = 10) and less than 30 kg/m2 defined as nonobese (n = 20).
At baseline, BMD and z scores did not differ between the two groups at the lumbar spine, femoral neck, total hip or distal radius. At 24 months, participants with obesity compared with participants without obesity had greater increase in BMD at the lumbar spine (4.3% vs. 3.8%), femoral neck (3.8% vs. 3.1%) and total hip (4.3% vs. 2.8%); no significant difference was observed between the two groups for improvements in distal radius BMD.
TBS values were decreased in participants with obesity compared with participants without obesity, and those with obesity continually had TBS levels less than normal throughout the study despite BMD improvements.
“Our results demonstrate the detrimental effect of obesity on TBS, a clinically useful index of bone quality, in subjects with [primary hyperparathyroidism],” the researchers wrote. “By TBS, obese subjects showed evidence of fully degraded trabecular microarchitecture, despite similar value in bone mineral density by DXA compared to nonobese subjects. Following successful parathyroid surgery, obese subjects had persistently low TBS at 24 months despite improvement in BMD at the lumbar spine and femoral neck. In the nonobese subjects, TBS was only minimally reduced at baseline and persisted at this level throughout the 24 months post-parathyroid surgery period.” – by Amber Cox
Disclosures: Bilezikian reports he is a consultant for Amgen, Radius, Shire and Ultragenyx. Please see the study for all other authors’ relevant financial disclosures.
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