Bone remodeling |
Reduced |
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Bone turnover markers in the lower half of the normal range (1212 Rubin MR, Dempster DW, Sliney J Jr, Zhou H, Nickolas TL, Stein EM, et al. PTH(1–84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism. J Bone Miner Res. 2011;26(11):2727-36.,1616 Kovaleva EV, Eremkina AK, Elfimova AR, Krupinova JA, Bibik EE, Maganeva IS, et al. The Russian Registry of Chronic Hypoparathyroidism. Front Endocrinol (Lausanne). 2022;13:800119.).
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Dynamic histomorphometrical studies of transiliac bone biopsy presenting reduced mineralizing surface and bone formation rate (1010 Langdahl BL, Mortensen L, Vesterby A, Eriksen EF, Charles P. Bone histomorphometry in hypoparathyroid patients treated with vitamin D. Bone. 1996;18(2):103-8.–1212 Rubin MR, Dempster DW, Sliney J Jr, Zhou H, Nickolas TL, Stein EM, et al. PTH(1–84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism. J Bone Miner Res. 2011;26(11):2727-36.).
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BMD |
Mostly increased |
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BMD by DXA is increased at the LS and hip sites and similar to controls at the radius (55 Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, et al. Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab. 2012;97(12):4507-14.,66 Tay YD, Tabacco G, Cusano NE, Williams J, Omeragic B, Majeed R, et al. Therapy of Hypoparathyroidism With rhPTH(1–84): A Prospective, 8-Year Investigation of Efficacy and Safety. J Clin Endocrinol Metab. 2019;104(11):5601-10.,1111 Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J Jr, et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. 2008;23(12):2018-24.,1717 Chawla H, Saha S, Kandasamy D, Sharma R, Sreenivas V, Goswami R. Vertebral Fractures and Bone Mineral Density in Patients With Idiopathic Hypoparathyroidism on Long-Term Follow-Up. J Clin Endocrinol Metab. 2017;102(1):251-8.–2424 Cipriani C, Minisola S, Bilezikian JP, Diacinti D, Colangelo L, Piazzolla V, et al. Vertebral Fracture Assessment in Postmenopausal Women With Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab. 2021;106(5):1303-11.).
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Volumetric BMD at the cortical and trabecular compartments is increased by pQCT (2020 Chen Q, Kaji H, Iu MF, Nomura R, Sowa H, Yamauchi M, et al. Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab. 2003;88(10):4655-8.).
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Total volumetric BMD is increased by HRpQCT; data on cortical volumetric BMD are diverse (3232 Cusano NE, Nishiyama KK, Zhang C, Rubin MR, Boutroy S, McMahon DJ, et al. Noninvasive Assessment of Skeletal Microstructure and Estimated Bone Strength in Hypoparathyroidism. J Bone Miner Res. 2016;31(2):308-16.,3333 Cusano NE, Rubin MR, Williams JM, Agarwal S, Tabacco G, Tay D, et al. Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1–84) Therapy in Hypoparathyroidism. J Bone Miner Res. 2020;35(7):1274-81.).
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Bone microarchitecture |
Preserved at the cancellous compartment |
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TBS is increased or similar to that in controls (2929 Iglesias SG, Dominguez MLM, Herrero EF, Martinez-Pueyo JI, Arroba CM, Diaz-Guerra GM, et al. Trabecular bone score and bone mineral density in patients with postsurgical hypoparathyroidism after total thyroidectomy for differentiated thyroid carcinoma. Surgery. 2019;165(4):814-9.–3131 Sakane EN, Vieira MCC, Lazaretti-Castro M, Maeda SS. Predictors of Poor Bone Microarchitecture Assessed by Trabecular Bone Score in Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab. 2019;104(12):5795-803.).
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Increased trabecular number and decreased trabecular separation by HRpQCT (3232 Cusano NE, Nishiyama KK, Zhang C, Rubin MR, Boutroy S, McMahon DJ, et al. Noninvasive Assessment of Skeletal Microstructure and Estimated Bone Strength in Hypoparathyroidism. J Bone Miner Res. 2016;31(2):308-16.,3333 Cusano NE, Rubin MR, Williams JM, Agarwal S, Tabacco G, Tay D, et al. Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1–84) Therapy in Hypoparathyroidism. J Bone Miner Res. 2020;35(7):1274-81.).
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Data on cortical thickness and porosity are diverse according to HRpQCT studies (3232 Cusano NE, Nishiyama KK, Zhang C, Rubin MR, Boutroy S, McMahon DJ, et al. Noninvasive Assessment of Skeletal Microstructure and Estimated Bone Strength in Hypoparathyroidism. J Bone Miner Res. 2016;31(2):308-16.,3333 Cusano NE, Rubin MR, Williams JM, Agarwal S, Tabacco G, Tay D, et al. Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1–84) Therapy in Hypoparathyroidism. J Bone Miner Res. 2020;35(7):1274-81.).
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Estimated bone strength |
Controversial |
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Increased (3333 Cusano NE, Rubin MR, Williams JM, Agarwal S, Tabacco G, Tay D, et al. Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1–84) Therapy in Hypoparathyroidism. J Bone Miner Res. 2020;35(7):1274-81.) or reduced (3232 Cusano NE, Nishiyama KK, Zhang C, Rubin MR, Boutroy S, McMahon DJ, et al. Noninvasive Assessment of Skeletal Microstructure and Estimated Bone Strength in Hypoparathyroidism. J Bone Miner Res. 2016;31(2):308-16.) bone strength by finite element analyses of HRpQCT images.
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Reduced bone strength by microindentation of the tibia (3434 Starr JR, Tabacco G, Majeed R, Omeragic B, Bandeira L, Rubin MR. PTH and bone material strength in hypoparathyroidism as measured by impact microindentation. Osteoporos Int. 2020;31(2):327-33.).
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