Osteoporosis and Hyperparathyroidism

Calcium is what makes our bones strong.  Osteoporosis is a term that describes the loss of calcium from the bone so the bone is no longer thick or dense.  The process of losing bone mass can cause bone pain which is common complaint amongst persons suffering with primary hyperparathyroidism.  Osteoporotic bones are also more fragile than regular bones and therefore they are susceptible to fractures and breaks. Hip fracture is especially prevelant and debilitating in elderly persons and may be hastened by osteoporosis. The parathyroid glands control how much calcium is released from our bones through the action of PTH on osteoclasts, which are cells that break down bone. Osteoblasts are the cells that build bone and together osteoclasts and osteoblasts work to constantly remodel bone.

Thinning of the bones can become manifest on plain x-rays of the bones as well as a test called a Bone Mineral Density Test (BMD) or Dexa Scan.

Here you can see on plain films of the legs the distal tibea bone very thin and osteoporotic.

For women, it is important that they build up their calcium stores and bone strength before menopause as estrogens have a protective effect on bone density.  After menopause women lose bone density at a faster rate than men of the same age.  When an overactive parathyroid gland is further contributing to calcium loss from the bones this hastens osteoporosis. 

Removing a parathyroid adenoma that is causing hyperparathyroidism is known to stop the rapid thinning of bones.  This is why it is so important to seek surgical intervention for hyperaparathyroidism.  Even if you don't have any symptoms, this loss of bone density becomes increasingly difficult to reverse and replace.

After your parathyroid surgery it is important that you take calcium and vitamin D supplements to help replenish your calcium stores in your bones.  There is also a class of drug called a biphosphonate such as Actonel, Evista, Miacalcin and Fosamax that inhibit the digestion of bone by inhibiting osteoclasts.  This class of drug is indicated in post-menopausal women with osteopenia or osteoporosis.  You should speak with your private doctor or endocrinologist about considering  to use these drugs before or after surgery.  These drugs will not prevent the bone loss that occurs with a parathyroid tumor, therefore it is important that these drugs not be used as substitutes for surgical intervention.

Other drugs that are also considered that may help build bone stores include estrogens and Calcitonin. Lithium therapy and thiazide diuretics should be avoided. Also adequate fluid intake and exercise are important.

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