Background:
Osteoporosis in Primary hyperparathyroidism (PHPT) is secondary to catabolic effect promoting osteoclast activity and bone resorption and this effect is predominant at cortical sites. The aim of study was to assess P1NP (bone formation marker) and CTX (resorption marker) as markers of accelerated bone turnover in patients with parathyroid disease and the effect of surgery.

Material and Methods:
Retrospective study of patients diagnosed with parathyroid disease between Jan 2005–Dec2012 at a district general hospital. Serum calcium, intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP), PINP and CTX were measured serially. Outcomes measured were cure, improvement in bone turnover markers and improvement in bone density on DEXA scans at 1 year post intervention. Patients with Vitamin D deficiency were treated with Vit D before intervention.

Result:
133 (112F:21M) patients (age 25-91 range yrs) underwent treatment for parathyroid disease. 10 patients were treated conservatively and 123 proceeded to surgery following localisation studies. Surgical treatment was with an open exploration under GA for adenoma (n=115) and hyperplastic disease (n=8). Following intervention PINP dropped significantly from a mean of 65.01ug/l to 25.63ug/l and CTX from 0.64ug/l to 0.16ug/l at 6 months. This change was reflected in improvement in BMD (T- scores) (3-17%) of both hip and spine.

In 5 patients where surgical intervention failed there was no drop in the bone turn over markers.

Conclusion:
CTX and PINP are good biochemical markers to predict improvement in bone mineral density in patients with primary hyperparathyroidism following surgery.