This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khan, A. Articles by Shoback, D. Search for Related Content PubMed PubMed Citation Articles by Khan, A. Articles by Shoback, D. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CALCIUM COMPOUNDS CALCIUM, ELEMENTAL PARATHYROID HORMONE Related Collections Calcium and Bone Metabolism Endocrine Oncology

Medical Management of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

McMaster University (A.K.), Hamilton, Ontario, Canada L8S 4L8; University of Auckland (A.G.), Auckland 1142, New Zealand; and University of California, San Francisco (D.S.), San Francisco, California 94143

Address all correspondence and requests for reprints to: Aliya Khan, M.D., FRCPC, FACP, FACE, Professor of Clinical Medicine, McMaster University, 331 Sheddon Avenue, #209, Oakville, Ontario, Canada L6J 5T4. E-mail: aliya{at}mcmaster.ca.

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that is frequently asymptomatic. The 2002 International Workshop on Asymptomatic PHPT addressed medical management of asymptomatic PHPT and summarized the data on nonsurgical approaches to this disease. At the Third International Workshop on Asymptomatic PHPT held in May 2008, this subject was reviewed again in light of data that have since become available. We present the results of a literature review of advances in the medical management of PHPT.

Methods: A series of questions was developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies evaluating the management of PHPT with bisphosphonates, hormone replacement therapy, raloxifene, and calcimimetics was conducted. Existing guidelines and recent unpublished data were also reviewed. All selected relevant articles were reviewed, and the questions developed by the International Task Force were addressed by the Consensus Panel.

Results: Bisphosphonates and hormone replacement therapy are effective in decreasing bone turnover in patients with PHPT and improving bone mineral density (BMD). Fracture data are not available with either treatment. Raloxifene also lowers bone turnover in patients with PHPT. None of these agents, however, significantly lowers serum calcium or PTH levels. The calcimimetic cinacalcet reduces both serum calcium and PTH levels and raises serum phosphorus. Cinacalcet does not, however, reduce bone turnover or improve BMD.

Conclusions: Bisphosphonates and hormone replacement therapy provide skeletal protection in patients with PHPT. Limited data are available regarding skeletal protection in patients with PHPT treated with raloxifene. Calcimimetics favorably alter serum calcium and PTH in PHPT but do not significantly affect either bone turnover or BMD. Medical management of asymptomatic PHPT is a promising option for those who are not candidates for parathyroidectomy.

This article has been cited by other articles:

				J. P. Bilezikian, A. A. Khan, J. T. Potts Jr, and on behalf of the Third International Workshop on t Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 335 - 339. [Abstract] [Full Text] [PDF]