NDT Advance Access published online on February 16, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl837
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Significance of time-course changes of serum bone markers after parathyroidectomy in patients with uraemic hyperparathyroidism
1Department of Nephrology, Towa Hospital, 4-7-10, Towa, Adachi-ku, Tokyo, 120-0003, 2Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, 3Department of Urology and Transplant Surgery, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-0064, 4Department of Transplant Surgery, Nagoya Second Red Cross Hospital, 2-9, Myomi-machi, Showa-ku, Nagoya-city, Aichi, 466-8650, 5Department of Orthopedic Surgery, Tanizawa Orthopedic Clinic, 1134, 6 Ban-cho, Honchou-douri, Niigata-city, Niigata, 951-2074 and 6Department of Nephrology and Surgery, Sangenjaya Hospital, 1-21-5, Sangenjaya, Setagaya-ku, Tokyo, 154-0024, Japan
Correspondence and offprint requests to: Aiji Yajima, Towa Hospital, 4-7-10, Towa, Adachi-ku, Tokyo, 120-0003, Japan. Email: a-and-y{at}rj8.so-net.ne.jp
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Abstract |
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Background. The increase of bone mineral density in cortical bone after parathyroidectomy is smaller than that in cancellous bone. Changes of serum bone markers reflect those of bone metabolism both in cortical and cancellous bone after parathyroidectomy. The present study was undertaken to investigate changes of histomorphometric parameters of cortical and cancellous bone together and their correlation with those of serum bone markers.
Methods. Iliac bone biopsy was performed before and 1 week after parathyroidectomy in Group I (n = 13), and before and 4 and 12 weeks after in Group II (n = 11). Moreover, changes of histomorphometric parameters of the endocortical, intracortical and periosteal surfaces as well as in cancellous bone were monitored. Serum levels of intact parathyroid hormone and bone markers were measured simultaneously.
Results. In cancellous bone, osteoclast surface (Oc.S/BS) decreased to 0% within 4 weeks after parathyroidectomy, while osteoblast surface (Ob.S/BS) transiently increased at 1 week, followed by a reduction at 4 weeks to levels below the pre-surgical level. In cortical bone, Oc.S/BS was not reduced to 0%, while a significant and temporary increase of Ob.S/BS was observed only on the endocortical and intracortical surfaces at 4 weeks, but not at 1 week. Serum bone resorption markers did not completely disappear and significant and sustained increases of bone formation markers were observed until 4 weeks after parathyroidectomy.
Conclusions. Changes of bone formation markers lagged behind those of histomorphometric parameters in cancellous bone because changes of cortical bone were observed later and were incomplete compared with those of cancellous bone.
Keywords: endocortical surface; intracortical surface; parathyroidectomy; periosteal surface; secondary hyperparathyroidism; serum bone markers
Received for publication: 26. 6.06
Accepted in revised form: 26.12.06