Alendronate in the Treatment of Primary Hyperparathyroid-Related Osteoporosis: A 2-Year Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 87; no. 10; pp. 4482 - 4489
• Main Authors: Parker, C. R, Blackwell, P. J, Fairbairn, K. J, Hosking, D. J
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.10.2002
• Subjects: Absorptiometry, Photon; Alendronate - therapeutic use; Biological and medical sciences; Bone Density; Calcium - blood; Calcium - urine; Creatinine - blood; Creatinine - urine; Diseases of the osteoarticular system; Female; Hormones. Endocrine system; Humans; Hydroxyproline - urine; Hyperparathyroidism - complications; Male; Medical sciences; Middle Aged; Osteocalcin - blood; Osteoporosis - drug therapy; Osteoporosis - etiology; Osteoporosis. Osteomalacia. Paget disease; Parathyroid Hormone - blood; Pharmacology. Drug treatments; Phosphates - blood; Time Factors; Endocrinopathy; Human; Treatment efficiency; Diseases of the osteoarticular system; Diphosphonic acid derivatives; Bone disease; Antihypercalcemic agent; Calcemia; Bisphosphonates; Blood plasma; Alendronic acid; Osteoporosis; Parathormone; Chemotherapy; Treatment; Parathyroid hormone; Parathyroid diseases; Complication; Bone mineral density; Hormonal investigation; Hyperparathyroidism
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2001-010385

We investigated the effect of alendronate on calcium, PTH, and bone mineral density in 27 female and 5 male patients with primary hyperparathyroidism. The treatment group [n = 14; T score ≤ −2.5 sd at the femoral neck (FN) or T ≤ −1.0 sd plus previous nonvertebral fracture] was given alendronate 10 mg/d for 24 months. The second group (n = 18; T score > −2.5 sd at the FN) was untreated. Biochemistry was repeated at 1.5, 3, 6, 12, 18, and 24 months, and dual-energy x-ray absorptiometry at 12 and 24 months. There were no significant between-group baseline differences in calcium, creatinine, or PTH. Alendronate-treated patients gained bone at all sites [lumbar spine (LS), 1 yr gain, +7.3 ± 1.7%; P < 0.001; 2 yr, +7.3 ± 3.1%; P = 0.04). Untreated patients gained bone at the LS over 2 yr (+4.0 ± 1.8%; P = 0.03) but lost bone elsewhere. Calcium fell nonsignificantly in the alendronate group between baseline (2.84 ± 0.12 mmol/liter) and 6 wk (2.76 ± 0.09 mmol/liter), with a nonsignificant rise in PTH (baseline, 103.5 ± 14.6 ng/liter; 6 wk, 116.7 ± 15.6 ng/liter). By 3 months, values had reverted to baseline. In primary hyperparathyroidism, alendronate is well tolerated and significantly improves bone mineral density at the LS (with lesser gains at FN and radius), especially within the first year of treatment. Short-term changes in calcium and PTH resolve by 3 months.