Bone metabolism on long-term follow-up after total parathyroidectomy with autotransplantation

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 26; no. 9; pp. 1515 - 1519
• Main Authors: Miyazaki, Masashi, Miyoshi, Kazuya, Kodera, Masato, Sakagami, Kenichi, Orita, Kunzo, Tanaka, Shinichiro, Kokumai, Yoshiaki, Uchida, Susumu, Takatsu, Shigeko, Shiozaki, Shigehiro, Takasu, Shinji
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1993
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.26.1515

Total parathyroidectomy with autotransplantation (PTX-AT) has been widely accepted as treatment for renal osteodystrophy (ROD). However, there are few reports of long-term bone formation and mineralization following PTX-AT. Twenty-seven of 38 patients who underwent PTX-AT during the past eight years have been followed up more than three years (mean 61.9±11.9 months). The duration of hemodialysis was 120-235 months (mean 181.1±30.7 months). In 22 cases, serum C-PTH decreased immediately and remained at less than 5ng/ml three years after surgery. However, four of the remaining 5 cases who had recurrence in residual parathyroid gland showed high levels of C-PTH after surgery. Serum osteocalcin was measured in the PTX-AT and secondary hyperparathyroidism (2°HPT) groups whose C-PTH level was more than 10ng/ml. The levels of osteocalcin in the PTX-AT and 2°HPT groups were 106.9±98.7ng/ml and 230.9±157.9ng/ml (mean±SD), respectively. The difference between the two groups was significant (p<0.005). The skeleton was examined radiologically before and after surgery. Tuft resorption of the finger bones and salt-and pepper appearance of the skull improved remarkably in 91.3% and 95.2%, respectively. However, rugger jersey appearance of the spine improved in only 47.6%. In particular, four cases who had persistent 2°HPT after surgery showed a low rate of improvement on bone X-ray. Serum C-PTH and osteocalcin, as biochemical markers of bone metabolism, may correlate with bone X-ray findings.