Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism
Background: Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Bone Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187221003776 |
| _version_ | 1818694729836003328 |
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| author | Irene Ruderman Chamith S. Rajapakse Winnie Xu Sisi Tang Patricia L. Robertson Nigel D. Toussaint |
| author_facet | Irene Ruderman Chamith S. Rajapakse Winnie Xu Sisi Tang Patricia L. Robertson Nigel D. Toussaint |
| author_sort | Irene Ruderman |
| collection | DOAJ |
| description | Background: Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods: We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results: Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion: Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness. |
| first_indexed | 2024-12-17T13:34:13Z |
| format | Article |
| id | doaj.art-d5872dce169f4ed5a3074dd3c0f13fc7 |
| institution | Directory Open Access Journal |
| issn | 2352-1872 |
| language | English |
| last_indexed | 2024-12-17T13:34:13Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Bone Reports |
| spelling | doaj.art-d5872dce169f4ed5a3074dd3c0f13fc72022-12-21T21:46:29ZengElsevierBone Reports2352-18722021-12-0115101120Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidismIrene Ruderman0Chamith S. Rajapakse1Winnie Xu2Sisi Tang3Patricia L. Robertson4Nigel D. Toussaint5Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia; Corresponding author at: Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia.Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USADepartments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USADepartments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USADepartment of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, AustraliaDepartment of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, AustraliaBackground: Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods: We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results: Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion: Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.http://www.sciencedirect.com/science/article/pii/S2352187221003776Secondary hyperparathyroidismRenal osteodystrophyMagnetic resonance imagingParathyroidectomyChronic kidney disease |
| spellingShingle | Irene Ruderman Chamith S. Rajapakse Winnie Xu Sisi Tang Patricia L. Robertson Nigel D. Toussaint Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism Bone Reports Secondary hyperparathyroidism Renal osteodystrophy Magnetic resonance imaging Parathyroidectomy Chronic kidney disease |
| title | Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| title_full | Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| title_fullStr | Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| title_full_unstemmed | Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| title_short | Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| title_sort | changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism |
| topic | Secondary hyperparathyroidism Renal osteodystrophy Magnetic resonance imaging Parathyroidectomy Chronic kidney disease |
| url | http://www.sciencedirect.com/science/article/pii/S2352187221003776 |
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