OBJECTIVE In primary hyperparathyroidism (PHPT) with osteoporosis, bone mineral density (BMD) improves after parathyroidectomy. It is unclear whether combining surgery with postoperative bisphosphonate treatment can further improve bone health. DESIGN This randomized, placebo-controlled study compared the effects of surgery alone and surgery combined with zoledronic acid on bone metabolism in PHPT with osteoporosis. METHODS Fifty-six patients (f/m 47/9, mean age 68.4 years) with PHPT and osteoporosis were randomized 1-3 months after parathyroidectomy to receive a 2-year treatment of zoledronic acid or placebo. Dual-energy X-ray absorptiometry (DXA) and bone turnover markers (N-terminal propeptide of type 1 procollagen, C-terminal telopeptide of type 1 collagen, and alkaline phosphatase) were measured annually during the 2-year follow-up. RESULTS Two years after parathyroidectomy, BMD was significantly higher in the zoledronic acid (ZOL) group compared with the placebo (PBO) group at the femoral neck (P = 0.045 for Z-score) and lumbar spine (P = 0.039 and 0.017 for T- and Z-scores, respectively). Bone turnover markers were significantly lower in the ZOL group (P < 0.001 for all markers). Of the 18 patients who had received bisphosphonates for >1 year before surgery, BMD improved significantly in the ZOL group both in the femoral neck and lumbar spine (n = 10; all P < 0.001-0.01), but in the PBO group, only in the lumbar spine (n = 8, P = 0.03), (P = 0.08-0.95 for between-group changes). CONCLUSION BMD increases after parathyroidectomy both with and without zoledronic acid but the increase is significantly higher with postoperative zoledronic acid.

中文翻译：

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术后唑来膦酸治疗原发性甲状旁腺功能亢进症骨质疏松症：一项随机安慰剂对照研究。

目的 在伴有骨质疏松症的原发性甲状旁腺功能亢进 (PHPT) 中，甲状旁腺切除术后骨矿物质密度 (BMD) 得到改善。目前尚不清楚将手术与术后双膦酸盐治疗相结合是否可以进一步改善骨骼健康。设计 这项随机、安慰剂对照研究比较了单独手术和手术联合唑来膦酸对 PHPT 合并骨质疏松症骨代谢的影响。方法 56 名 PHPT 和骨质疏松症患者（f/m 47/9，平均年龄 68.4 岁）在甲状旁腺切除术后 1-3 个月随机接受唑来膦酸或安慰剂治疗 2 年。在 2 年的随访期间，每年测量一次双能 X 线骨密度仪 (DXA) 和骨转换标志物（1 型前胶原的 N 端前肽、1 型胶原的 C 端端肽和碱性磷酸酶）。结果 甲状旁腺切除术后两年，与安慰剂（PBO）组相比，唑来膦酸（ZOL）组股骨颈（Z 评分 P = 0.045）和腰椎（T 评分 P = 0.039 和 0.017）的 BMD 显着高于安慰剂（PBO）组。 - 和 Z 分数，分别）。ZOL 组的骨转换标志物显着降低（所有标志物的 P < 0.001）。在术前接受双膦酸盐治疗超过 1 年的 18 名患者中，ZOL 组股骨颈和腰椎的 BMD 均显着改善（n = 10；均 P < 0.001-0.01），但在 PBO 组中，仅在腰椎（n = 8，P = 0.03），（组间变化 P = 0.08-0.95）。结论 甲状旁腺切除术后有和没有唑来膦酸的 BMD 增加，但术后唑来膦酸的增加明显更高。