Case studies

Endocrine causes of osteoporosis. Part 1: Primary hyperparathyroidism

Madhuni Herath, FRANCES MILAT, PHILLIP WONG

Figures

© dubova/abdobestock model used for illustrative purposes only
© dubova/abdobestock model used for illustrative purposes only

Abstract

Endocrine causes of osteoporosis, such as primary hyperparathyroidism, hypogonadism, glucocorticoid excess, acromegaly, Cushing’s syndrome and hyperthyroidism, are well-recognised risk factors for decreased bone mineral density. Optimal management of bone health in people with these conditions involves treating the underlying hormonal disease and assessing the need for specific bone preservation therapy. This three-part series discusses the management of three different cases to highlight the detrimental impact of specific endocrine disease on bone health.

Key Points

  • Elevated serum calcium and parathyroid hormone levels should raise the suspicion of underlying primary hyperparathyroidism.
  • Measurement of bone mineral density at the lumbar spine, femoral neck and distal 1/3 radius using dual x-ray absorptiometry (DXA) is recommended in patients with primary hyperparathyroidism.
  • Vitamin D replacement to a level above 50 nmol/L should be encouraged to reduce the potential risk of hungry bone syndrome after parathyroidectomy.
  • Surgical resection is recommended for patients with symptomatic primary hyperparathyroidism and for asymptomatic patients who have a calcium level greater than 0.25 mmol/L above the upper limit of normal, renal impairment, nephrolithiasis or skeletal involvement (minimal trauma fracture or osteoporosis confirmed by DXA) or are under 50 years of age.
  • A parathyroid Sestamibi and neck ultrasound should only be undertaken if a decision to proceed to surgery is made. A referral of the patient to an endocrinologist may be appropriate in these cases.

Figures

© dubova/abdobestock model used for illustrative purposes only
© dubova/abdobestock model used for illustrative purposes only