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Oral Alendronate Increases Bone Mineral Density in Postmenopausal Women with Primary Hyperparathyroidism

Departments of Medicine and Therapeutics (C.C.C., W.B.C., N.N.C., C.S.C.) and Chemical Pathology (M.H.M.C.), The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Medicine, Yan Chai Hospital, Hong Kong (J.K.Y.L.); Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong (G.T.C.K.); and Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong (K.W.L.)

Address all correspondence and requests for reprints to: Dr. C. C. Chow, Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. E-mail: ccf193chow{at}cuhk.edu.hk.

The effect of biphosphonate therapy on bone mineral density (BMD) in patients with primary hyperparathyroidism (PHP) is unknown. Forty postmenopausal women (mean age, 70 yr) with PHP were randomized to receive alendronate 10 mg/d or placebo for 48 wk, followed by treatment withdrawal for 24 wk. The mean (±SD) changes in BMD at femoral neck (+4.17 ± 6.01% vs. -0.25 ± 3.3%; P = 0.011) and lumbar spine (+3.79 ± 4.04% vs. 0.19 ± 2.80%; P = 0.016) were significantly higher with alendronate at 48 wk. Serum calcium was reduced with alendronate but not placebo (-0.09 vs. +0.01 mmol/liter; P = 0.018). Serum bone-specific alkaline phosphatase activity was lower with alendronate from 12 wk onward and increased 24 wk after treatment withdrawal (21.1 ± 12.8 to 7.3 ± 4.9 IU/liter at 48 wk, and 15.0 ± 14.8 IU/liter 24 wk after withdrawal; P = 0.002 for trend). Osteocalcin concentration decreased at 48 wk and increased 24 wk after alendronate withdrawal (P = 0.019 for trend of change over time) but not with placebo. Urinary N-telopeptide/creatinine ratio decreased with alendronate at 48 wk and increased 24 wk after treatment withdrawal (P = 0.008 for trend). N-telopeptide/creatinine ratio did not change with placebo. Alendronate improves BMD and reduces bone turnover markers in postmenopausal women with PHP.

This study was supported in part by the Medical School Grant Program from Merck \|[amp ]\| Co., Inc.

Abbreviations: BMD, Bone mineral density; Bone-ALP, bone-specific alkaline phosphatase activity; CV, coefficient(s) of variation; HRT, hormone replacement therapy; PHP, primary hyperparathyroidism.

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