A Strategy for the Management of Elderly Women with Primary Hyperparathyroidism: A Comparison of Etidronate Therapy with Parathyroidectomy

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Abstract
Objective: To evaluate the efficacy of etidronate (EHDP) on lumbar spine bone mineral density (LSBMD) and total bone mineral density (TBMD) in elderly women with primary hyperparathyroidism (PHPT), we compared changes in LSBMD and TBMD between patients treated by EHDP therapy and parathyroidectomy (PTX). Subjects and Methods: Twenty-two PHPT patients were enrolled and randomized into two groups; 9 received EHDP and 13 underwent PTX. All patients were followed up for 1 year by measuring LSBMD, TBMD, serum calcium, inorganic phosphate, parathyroid hormone, 1,25-dihydroxyvitamin D, serum alkaline phosphatase, intact osteocalcin, urinary pyridinoline (Upyd) and urinary deoxypyridinoline (Udpd). The presence of spinal fractures was evaluated by X-ray photography before and after treatment. Results: EHDP treatment produced a significant increase in LSBMD of 10% compared with pretreatment levels after 1 year (p < 0.03, compared to baseline), while PTX produced a significant increase in LSBMD of 20% compared to pretreatment levels (p < 0.01). However, TBMD remained unchanged for 1 year after both EHDP administration and PTX. Among biochemical bone turnover markers, EHDP administration resulted in significant decreases in alkaline phosphatase by 78%, Upyd by 64% and Udpd by 37% after 12 months compared with the pretreatment levels (p < 0.05) and intact osteocalcin by 67% after 6 months (p < 0.05). There were no differences in the fracture rate between the EHDP and PTX groups during 1 year. Conclusion: EHDP administration results in a somewhat lower increase in LSBMD than that following PTX and suppresses bone formation and resorption in elderly PHPT patients for 1 year. We conclude that PTX is preferable to EHDP therapy for the management of elderly PHPT patients; however, EHDP administration should also be considered for elderly patients with many complications or who are unfit for surgery.