Parathyroidectomy followed by kidney transplantation can improve bone mineral density in patients with secondary hyperparathyroidism.

BACKGROUND

We studied bone mineral density (BMD) after total parathyroidectomy plus autotransplantation (TPTD plus AT) followed by kidney transplantation in patients with symptomatic secondary hyperparathyroidism.

METHODS

We recruited 43 patients who were operated on with TPTD plus AT for this study. Group A (n=36) patients continued hemodialysis regularly thereafter; Group B (n=7) patients were followed by cadaveric kidney transplantation. In group A, serum calcium, phosphorus, alkaline phosphatase (Alk-ptase) and intact parathyroid hormone (iPTH) levels were measured at baseline, 1 week, and in the late follow-up period. In group B, serum calcium, phosphorus, Alk-ptase and iPTH levels were measured at baseline, 1 week after parathyroidectomy, and in the late follow-up period after kidney transplantation. The BMD of lumbar spine, femur, ulna and radius was measured with dual x-ray absorptiometry at baseline, and again at 1 year in group A and at 1 year after kidney transplantation in group B.

RESULTS

At 1 week after TPTD plus AT, calcium, phosphorus, and iPTH levels decreased significantly but Alk-ptase did not. In the late follow up period calcium, phosphorus, Alk-ptase and iPTH levels decreased significantly compared with those at baseline. In group A, the BMD of lumbar spine, femur, ulna and radius increased significantly 1 year later. In group B, the BMD of femur, ulna and radius increased significantly 1 year after kidney transplantation, but the BMD of lumbar spine did not.

CONCLUSION

TPTD plus AT followed by kidney transplantation performed for symptomatic secondary hyperparathyroidism can improve the BMD of femur, ulna, and radius.