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On the Mechanism of Cancellous Bone Preservation in Postmenopausal Women with Mild Primary Hyperparathyroidism¹

Regional Bone Center, New York State Department of Health, Helen Hayes Hospital (D.W.D., M.P.,X.-G.L., M.S., V.S., R.L.), West Haverstraw, New York 10993; the Departments of Pathology (D.W.D., M.P., V.S.), Medicine (S.J.S., E.S., R.L., J.P.B.), and Pharmacology (J.P.B.), College of Physicians and Surgeons of Columbia University, New York, New York 10032; and the Department of Medicine, Creighton University (D.B.K., R.R.), Omaha, Nebraska 68131

Address all correspondence and requests for reprints to: David W. Dempster, Ph.D., Regional Bone Center, Helen Hayes Hospital, Route 9W, West Haverstraw, New York 10993. E-mail: daviddempster{at}mindspring.com

Several studies have demonstrated that cancellous bone mass and architecture are preserved in postmenopausal women with primary hyperparathyroidism (PHPT). To investigate the mechanism(s) that could account for this observation, we analyzed features of bone formation in 19 postmenopausal women with PHPT by bone histomorphometry. The results were compared with those from a comparable group of 34 healthy, postmenopausal women. Patients with PHPT were similar to control subjects in cancellous bone area as well as in trabecular width, separation, and number. However, in PHPT, elevations were observed in indexes of bone turnover, such as eroded surface, osteoid surface, mineralizing surface, bone formation rate at the tissue level, and activation frequency. At the level of the bone-remodeling unit, women with PHPT had significantly higher values for the wall width of trabecular bone packets (40.26 ± 0.36 vs. 34.58 ± 0.45 mm), the adjusted apposition rate (0.40 ± 0.04 vs. 0.29 ± 0.03 mm/day), and the active formation period (67.8 ± 5.1 vs. 57.3 ± 2.3 days). These findings are consistent with a stimulatory action of elevated PTH levels on the duration of the active bone formation phase in individual remodeling units and may account at least in part for the preservation of cancellous bone in postmenopausal women with mild PHPT.

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