Effetti a lungo termine del trattamento con bisfosfonati nell' iperparatiroidismo primario

LONG-TERM CONSEQUENCES OF A TREATMENT COURSE WITH BISPHOSPHONATES IN PRIMARY HYPERPARATHYROIDISM Abstract: In patients with primary hyperparathyroidism (PHPT) not suitable for surgical correction a skeletal protection with bisphosphonates is considered a reasonable option, but the longterm effects after treatment discontinuation are not well known. Sixty postmenopausal women with PHPT were given 400-600 IU vitamin D3 daily and 100 mg neridronate I.V. every two months for 2 years with 2 additional years of follow-up without anti-resorptive therapies. Bone mineral density (BMD) progressively rose by 6,6 ± 7,6% (SD) and by 2,9 ± 4,5% at the spine and femoral neck, respectively. During follow-up mean BMD progressively fell, but after 2 years it was still +3,9 ± 5,5% higher than baseline values at the spine. Bone alkaline phosphatase and serum C-Telopeptide of type-I-collagen decreased significantly within 6 months (28 and 49% versus baseline, respectively) and rose to baseline values within 6-12 months during follow-up. Serum PTH significantly rose from baseline during treatment, but it remained significantly higher than baseline during follow-up. The PTH changes were significantly correlated with serum 25-hydroxy-vitamin-D (25OHD) levels. In conclusion, in this study we observed that in patients with mild PHPT treatment with bisphosphonates is associated with the expected changes in bone turnover markers and that the significant increases of both hip and spine BMD are partially maintained for at least 2 years after treatment discontinuation at the vertebral site. The marked increases in serum PTH levels, particularly in subjects with low 25OHD levels, persist after treatment discontinuation, and this raises the suspicion that this might reflect a worsening of PHPT.