绝经前后妇女骨代谢生化指标与骨超声声速的关系

目的 观察绝经前后不同年龄妇女的骨超声声速和骨代谢生化指标的变化情况及相互关系。方法 共197例绝经前后妇女,其中89例为绝经前组,接年龄每隔10年分组,88例为绝经后组。用ELISA法测定各个骨形成与骨吸收指标,同时B超亩骨密度仪测定骨超声声速情况。结果 绝经前骨超声声速无明显改变,绝经后骨超声声速明显下降,骨超声声速在绝经后与年龄及绝经年限呈负相关。骨超声声速与骨吸收指标呈负相关。骨吸收指标Pyd不但在绝经后明显上升,且在绝经前的第3组妇女中已较前有明显升高。结论 骨代谢生化指标的改变先于骨超声声速的改变,骨量和骨代谢指标测定相结合,可能更有助于预测将来发生骨折的危险程度。     

女性绝经后骨质疏松症的中医中药治疗

女性绝经后骨质疏松症（ｐｏｓｔｍｅｎｏｐａｕｓａｌｏｓｔｅｏｐｏｒｏｓｉｓ）是指绝经后妇女由于卵巢功能衰退、雌激素水平下降,继发甲状旁腺功能亢进,降钙素分泌不足,从而导致骨吸收大于骨形成,出现以低骨量和骨组织的显微结构退行性变为其特征,临床表现为骨脆性和骨折易感性增加的一种代谢性疾病。骨质疏松症的临床表现大都为非特异性,若能仔细询问病史,患者多主诉为腰背和四肢慢性疼痛,骨质丧失本身无明显症状,但骨质丧失会使骨矿质减少,骨孔增多和脆性增加,从而导致骨骼强度下降,骨骼不能支持正常或轻微增加的压力,则…     

原发性甲状旁腺功能亢进外科诊治分析(附24例报告)

目的 讨论原发性甲状旁腺功能亢进(PHPT) 的临床表现、诊断、治疗与预后.方法 回顾性分析我院10年间收治的24例PHPT患者的临床资料.结果 女性发病多于男性;B超检查是首选,诊断的准确率为79.2%;CT联合99mTc-MIBI检查可以提高异位甲状旁腺腺瘤诊断的准确率;手术在定位明确的甲状旁腺腺瘤可行单侧探查.定位不明确或异位者可在CT与放射性核素指导下行手术探查;手术后均发生不同程度的低血钙症,应用钙剂后症状缓解,大部分患者骨痛缓解或泌尿系多发结石消失;未发现喉返神经损伤、永久性甲状旁腺功能减退等并发症.结论 PHPT早期手术治疗,效果良好,能明显减轻患者的症状,并且并发症较少.     

ԭ���Լ�״���ٹ��ܿ������󲢷�֢��Ԥ��������

原发性甲状旁腺功能亢进（简称原发性甲旁亢，PHPT）的常见病因为甲状旁腺腺瘤（占80％～85％），甲状旁腺增生（占15％-20％），甲状旁腺癌（约占0．02％-4．00％）。自从1925年Mandl成功施行首例甲状旁腺切除术以来，外科手术已成为PHPT治疗的首选方法”.随着甲状旁腺功能亢进手术例数的增加，术后并发症也时有报道。甲旁亢术后一旦出现并发症，往往较难处理。本文就PHPT术后并发症的预防和处理加以介绍。     

原发性甲状旁腺机能亢进患者术中监测甲状旁腺激素的临床意义

目的：探讨原发性甲状旁腺机能亢进症（PHPT）患者术中动态监测甲状旁腺激素（IOPTH）的临床价值。 方法：回顾性分析1998年1月—2012年1月行手术治疗的36例PHPT患者的临床资料,其中2005年以后术中行IOPTH监测患者22例（IOPTH组）,2005年以前术中未行IOPTH监测的患者14例（常规组）,比较两组的术中情况与治疗效果。 结果：与常规组比较,IOPTH组手术时间明显缩短[（72.95±24.34）min vs.（81.86±29.46）min,P=0.000],术后短期（1个月内）甲状旁腺功能恢复患者比例增加（90.9% vs. 57.1%,P=0.018）,永久性甲状旁腺功能减退发生率明显减少（4.5% vs. 28.6%,P=0.042）。IOPTH监测对于判断高功能病灶完全切除与否的敏感度为100%,准确率为95.5%。 结论：PHPT手术中,在术前定位基础上联合IOPTH,有助于判断功能亢进腺体是否全部切除,避免遗漏多发病变腺体及不必要的双侧探查,缩短手术时间,疗效确切。     

原发性甲状旁腺功能亢进症的外科诊治

目的： 探讨原发性甲状旁腺功能亢进症（PHPT）的外科诊治经验。 方法：回顾性分析2002—2012年间收治的86例PHPT患者的临床资料。 结果：首发症状表现为骨骼系统病变45例,泌尿系统症状21例,消化道症状14例;无症状者6例。术前86例患者平均血钙浓度（3.13±0.46）mmol/L,甲状旁腺素（PTH）中位浓度864.6 pmol/mL。B超检出率90.3%,99mTc-MIBI检出率95.0%,CT检出率78.6%。58例单纯单发甲状旁腺瘤（其中包括异位甲状旁腺腺瘤5例）行单侧颈部探查术;11例双侧甲状旁腺腺瘤,15例单发甲状旁腺腺瘤合并双侧结节性甲状腺肿,2例甲状旁腺增生行双侧颈部探查术。术后成功随访80例,时间3个月至6年,所有患者均无复发。 结论：血钙、血PTH是PHPT定性诊断的主要依据,B超、99mTc-MIBI是PHPT主要定位手段。手术治疗是最有效的方法,单侧颈部探查术是常用术式。     

原发性甲状旁腺功能亢进诊治的难点与进展

正原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)是甲状旁腺激素(parathyroid hormone,PTH)分泌异常增多导致的钙磷代谢紊乱,临床表现主要集中在骨骼系统和泌尿系统。病因为甲状旁腺腺瘤(85%)、甲状旁腺增生(15%)和甲状旁腺癌(1%～2%),治疗上首选手术切除,治愈率可达95%～99%。PHPT的发病率与年龄和性别有关,随着年龄增加发病率增高,女性发病率为男性2～3倍。PHP     

肾型原发性甲状旁腺功能亢进1例误诊分析

原发性甲状旁腺功能亢进(prmiary hyperparathyroidism,PHPT),简称甲旁亢,是由于甲状旁腺本身病变引起甲状旁腺素(parathyrin,PTH)合成与分泌过多,通过其对骨与肾的作用,导致高钙血症和低磷血症.本病多见于20～50岁成年人,亦可见于儿童与老人,女性多于男性.PHPT是一种好发于白种人的严重内分泌疾病,黄种人中较少见[1],在中国属于少见病,临床上常易误诊.将江苏省苏北人民医院收治的1例以反复发作的泌尿系结石为首发症状就诊的PHPT病例报道如下.     

原发性甲状旁腺功能亢进的外科治疗及评价

随着人们对甲状旁腺疾病认识的不断深入,临床诊断原发性甲状旁腺功能亢进（primary hyperparathyroidism,PHPT）的病例日趋增多。PHPT是导致血钙升高的最常见原因之一。由于甲状旁腺自身过度分泌甲状旁腺素从而引起血清钙水平升高,并导致全身多个系统出现损害,其中包括神经肌肉、消化道、心血管、关节及软组织、泌尿及骨骼系统。外科手术是治疗PHPT的重要手段,手术成败的关键在于术前精确定位,术中仅切除病变旁腺组织而保留正常旁腺组织,同时不破坏正常旁腺组织血供并保护周围重要组织,特别是喉返神经。     

原发性甲状旁腺功能亢进的手术治疗

复习相关文献 ,对原发性甲状旁腺功能亢进 (PHPT)的手术治疗作综述性报道如下 :(1 )PHPT手术径路选择目前仍存在争议 ;(2 )PHPT手术治疗的微创化已经取得长足进展 ;(3 )术中PTH的测定已成为PHPT术中诊断和评估手术效果的研究热点 ;(4)重视PHPT手术后复发与再手术的原因。     

Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism

Summary

In this study, we show that successful parathyroidectomy is followed at 1 year by a significant individual bone mineral density (BMD) gain in nearly half of normocalcemic PHPT patients with reduced bone mass. Alkaline phosphatase levels above median were identified as an independent predictor of individual BMD gain in normocalcemic PHPT patients.

Introduction

The aims of this study were to assess bone mineral density (BMD) gains after parathyroidectomy (PTX) in normocalcemic primary hyperparathyroidism (PHPT) at the individual level and to identify predictors of BMD gain after PTX in this context.

Methods

Longitudinal cohort study of 55 PHPT patients referred for low bone mass and mild abnormalities of calcium/phosphorus metabolism, and successfully treated by PTX. BMD gain at 1 year was considered significant if ≥0.030 g/cm² at one site or more, without any equivalent BMD loss at another site. A logistic regression analysis was performed to identify predictive factors of individual BMD gain.

Results

Among the 55 PHPT patients included, 29 patients with hypercalcemia, 36 patients with normocalcemic PHPT, defined by normal pre-PTX serum total (albumin-corrected) calcium (tCa), including 15 patients with normal ionized calcium (iCa), were identified. At 1 year of PTX, an individual BMD gain was observed in 73.7 % of hypercalcemic, 44.4 % of normocalcemic, and 46 % of PHPT patients with both normal tCa and iCa. Site-specific BMD gains were most important at the spine and hip in all subgroups including patients with normal iCa. Alkaline phosphatase activity above median, which reflects high bone turnover, was predictive of individual BMD gain, both in the overall cohort (OR?=?4.9, 95 % CI 1.3–18.9), and in the normocalcemic group: OR?=?8.4, 95 % CI 1.4–56.6.

Conclusions

Successful PTX is followed at 1 year by a significant individual BMD gain in nearly half of normocalcemic PHPT patients with osteoporosis. ALP levels above median could contribute to the therapeutic decision in this context.     

Remarkable increase in lumbar spine bone mineral density and amelioration in biochemical markers of bone turnover after parathyroidectomy in elderly patients with primary hyperparathyroidism: a 5-year follow-up study

We evaluated the efficacy of parathyroidectomy (PTX) on bone mineral density (BMD) and hormonal and biochemical markers of bone metabolism in elderly primary hyperparathyroidism (PHPT) patients, and followed these patients for 5 years after PTX. Eleven PHPT patients were enrolled and were followed for 5 years by measuring lumbar spine BMD (LSBMD), femoral BMD (FBMD), radial BMD (RBMD), parathyroid hormone (PTH), 1,25-dihydroxyvitamin D [1,25(OH)₂D], serum calcium (SCa), inorganic phosphate (iP), bone-specific alkaline phosphatase (BAP), intact osteocalcin (IOC), urinary excretion of type I collagen cross-linked N-telopeptide (NTx), and urinary deoxypyridinoline (DPD). PTX produced significant increases in LSBMD of 12%, 19%, and 29% as compared with pretreatment levels after 1, 3, and 5 years, respectively (P < 0.01, compared to baseline), whereas there was no significant increase in FBMD and a slight decrease in RBMD. SCa and iP levels remained normal over the five years. PTX also resulted in significant decreases in PTH, 1,25(OH)₂D, BAP, IOC, NTx, and DPD that continued for at least 3 years after PTX. In conclusion, PTX seemed effective to normalize various markers of bone metabolism in elderly PHPT patients and is recommended to patients with low LSBMD to prevent future fractures. On the other hand, the use of PTX for low FBMD or RBMD patients requires further discussion.     

Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: a one-year prospective controlled study using high-resolution peripheral quantitative computed tomography

Following parathyroidectomy (PTX), bone mineral density (BMD) increases in patients with primary hyperparathyroidism (PHPT), yet information is scarce concerning changes in bone structure and strength following normalization of parathyroid hormone levels postsurgery. In this 1‐year prospective controlled study, high‐resolution peripheral quantitative computed tomography (HR‐pQCT) was used to evaluate changes in bone geometry, volumetric BMD (vBMD), microarchitecture, and estimated strength in female patients with PHPT before and 1 year after PTX, compared to healthy controls. Twenty‐seven women successfully treated with PTX (median age 62 years; range, 44–75 years) and 31 controls (median age 63 years; range, 40–76 years) recruited by random sampling from the general population were studied using HR‐pQCT of the distal radius and tibia as well as with dual‐energy X‐ray absorptiometry (DXA) of the forearm, spine, and hip. The two groups were comparable with respect to age, height, weight, and menopausal status. In both radius and tibia, cortical (Ct.) vBMD and Ct. thickness increased or were maintained in patients and decreased in controls (p < 0.01). Radius cancellous bone architecture was improved in patients through increased trabecular number and decreased trabecular spacing compared with changes in controls (p < 0.05). No significant cancellous bone changes were observed in tibia. Estimated bone failure load by finite element modeling increased in patients in radius but declined in controls (p < 0.001). Similar, albeit borderline significant changes in estimated failure load were found in tibia (p = 0.06). This study showed that females with PHPT had improvements in cortical bone geometry and increases in cortical and trabecular vBMD in both radius and tibia along with improvements in cancellous bone architecture and estimated strength in radius 1 year after PTX, reversing or attenuating age‐related changes observed in controls. © 2012 American Society for Bone and Mineral Research.     

Effect of Surgery Versus Observation: Skeletal 5‐Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study)

Mild primary hyperparathyroidism (PHPT) is known to affect the skeleton, even though patients usually are asymptomatic. Treatment strategies have been widely discussed. However, long‐term randomized studies comparing parathyroidectomy to observation are lacking. The objective was to study the effect of parathyroidectomy (PTX) compared with observation (OBS) on bone mineral density (BMD) in g/cm² and T‐scores and on biochemical markers of bone turnover (P1NP and CTX‐1) in a prospective randomized controlled study of patients with mild PHPT after 5 years of follow‐up. Of 191 patients with mild PHPT randomized to either PTX or OBS, 145 patients remained for analysis after 5 years (110 with validated DXA scans). A significant decrease in P1NP (p < 0.001) and CTX‐1 (p < 0.001) was found in the PTX group only. A significant positive treatment effect of surgery compared with observation on BMD (g/cm²) was found for the lumbar spine (LS) (p = 0.011), the femoral neck (FN) (p < 0.001), the ultradistal radius (UDR) (p = 0.042), and for the total body (TB) (p < 0.001) but not for the radius 33% (Rad33), where BMD decreased significantly also in the PTX group (p = 0.012). However, compared with baseline values, there was no significant BMD increase in the PTX group, except for the lumbar spine. In the OBS group, there was a significant decrease in BMD (g/cm²) for all compartments (FN, p < 0.001; Rad33, p = 0.001; UDR, p = 0.006; TB, p < 0.001) with the exception of the LS, where BMD was stable. In conclusion, parathyroidectomy improves BMD and observation leads to a small but statistically significant decrease in BMD after 5 years. Thus, bone health appears to be a clinical concern with long‐term observation in patients with mild PHPT. © 2017 American Society for Bone and Mineral Research.     

Vitamin D Supplementation After Parathyroidectomy: Effect on Bone Mineral Density—A Randomized Double‐Blind Study

Patients with primary hyperparathyroidism (PHPT) have higher bone turnover, lower bone mineral density (BMD), and an increased risk of fractures. They also have a high incidence of low vitamin D levels (25‐OH‐vitamin D <50 nmol/L) that could worsen the negative effect on the bone. In this double‐blinded clinical trial, 150 patients with PHPT were randomized, after successful parathyroidectomy (PTX), to 1‐year daily treatment with either cholecalciferol 1600 IU and calcium carbonate 1000 mg (D +) or calcium carbonate alone (D–). BMD was measured in the lumbar spine, femoral neck, total hip, distal and 33% radius using dual‐energy X‐ray absorptiometry (DXA) before surgery and after 1 year of study medication. Median age was 60 (range 30–80) years and there were 119 (79%) women and 31 (21%) men; 76% had 25‐OH‐D <50 nmol/L before PTX and 50% had persistent elevated parathyroid hormone (PTH) 6 weeks after PTX. A similar increase in BMD in the lumbar spine, femoral neck, and total hip was observed in both groups (D + : 3.6%, 3.2%, and 2.7%, p < 0.001, respectively; and D–: 3.0%, 2.3%, and 2.1%, respectively, p < 0.001). Patients with vitamin D supplementation also increased their BMD in distal radius (median 2.0%; interquartile range, ?1.7% to 5.4%; p = 0.013). The changes in BMD, especially in the hips, were correlated to the baseline concentrations of PTH, ionized calcium, and bone markers (p < 0.001). A benefit from vitamin D substitution was observed among patients with a persistent postoperative PTH elevation, who also improved their BMD at 33% radius and radius ultradistal (p < 0.05). In conclusion, except for a minor improvement of radius BMD, our data show no beneficial effect on BMD or bone turnover markers of vitamin D supplementation after PTX. Preoperative PTH seems to have the strongest association with improvement in BMD. © 2014 American Society for Bone and Mineral Research.     

原发性甲状旁腺机能亢进症手术治疗后骨量和骨代谢指标的变化

目的 了解甲状旁腺切除术对原发性甲状旁腺机能亢进症病人的骨矿密度及骨代谢指标变化的影响。方法 ４０例病人,其中３０例未治疗组（男：女＝３：２７）;１０例已手术治疗组（男：女＝３：７）,手术后时间１～２４月（平均５．３±７．９月）。用ＤＥＸＡ测量腰椎及股骨颈的骨矿密度,同时,测定血清中的甲状旁腺素（ＰＴＨ）,骨钙素（ＯＣ）,及骨唾液酸蛋白（ＢＳＰ）。结果 在已手术组病人其腰椎及股骨颈骨矿密度再没有明     

Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: A preliminary report

Parathyroid surgery is indicated in patients presenting with primary hyperparathyroidism (PHPT) and osteoporosis (defined as bone mineral density more than 2 standard deviations below normal). Many are elderly women with complex medical problems, either unwilling or considered unfit for surgery. Estrogen replacement therapy (ERT) may potentially be an alternative form of therapy in this group. We studied 15 consecutive postmenopausal women presenting with PHPT and osteoporosis. Group 1 comprised 5 women who elected to be treated with ERT (conjugated equine estrogen, 0.3–0.625 mg/day). The other 10 women underwent successful parathyroidectomy. These 10 patients were randomly subdivided into group 2 (5 patients who received calcitriol 0.25 µg b.i.d. for 12 months following surgery) and group 3 (5 patients who received elemental calcium 1 g/day for 12 months following surgery). Lumbar spine and femoral neck bone mineral density (BMD) were measured prior to and after 12 months of therapy, using a dual-energy X-ray absorptiometer (Lunar DPX-L). The three groups did not differ with respect to their ages (group mean 71.8 years), or baseline serum calcium (group mean 2.77 mmol/l), serum parathyroid hormone (group mean 11.0 pmol/l), lumbar spine BMD (group mean 0.93 g/cm²) and femoral neck BMD (group mean 0.73 g/cm²). Serum calcium normalized in all patients who underwent surgery and none developed hypoparathyroidism. A non-significant decrease in serum calcium was seen in patients treated with ERT only. Lumbar spine (+5.3% per year; 95% CI, 1.1% to 9.6%) and femoral neck BMD (+5.5% per year; 95% CI, –2.1% to 13.2%) increased significantly after 12 months of ERT (p<0.001 compared with pre-therapy values). These increases in BMD did not differ significantly from those in patients who underwent successful parathyroidectomy followed by either calcitriol therapy or calcium replacement (lumbar spine BMD increase of +6.2% per year, 95% CI 3.1% to 9.4%; and femoral neck BMD increase of +3% per year, 95% CI 0 to 6%). In summary, increases in lumbar spine and femoral neck BMD occur following treatment of PHPT. ERT appeared as effective as parathyroidectomy (combined with either calcitriol or calcium supplements) for the treatment of osteoporosis in elderly postmenopausal women presenting with PHPT.     

Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism: a prospective and randomized study

BACKGROUND: There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT) and how to grade their disease activity in terms of bone parameters. This prospective and randomized study was undertaken to evaluate skeletal effects of delayed surgical treatment in such patients. METHODS: Fifty patients with mild PHPT (serum calcium, 2.55 to 2.95 mmol/L; 10.2 to 11.8 mg/dL) were randomized to parathyroidectomy either at diagnosis or 1 year later. Hip and spine bone mineral density (BMD, determined by dual energy x-ray absorptiometry), bone alkaline phosphatase in serum, osteocalcin and beta-CrossLaps in plasma, and calcium in urine were measured in all patients at inclusion in the study and 1 and 2 years later. RESULTS: The skeletal effects of mild PHPT varied with anatomy and time of exposure. Parathyroidectomy decreased all biochemical bone markers ( P < .0001) and increased lumbar spine BMD ( P < .05) equally in both groups, even in patients without overt osteoporosis, whereas hip BMD was increased ( P < .05) in the early intervention group only. CONCLUSION: Prolonged exposure to mild and seemingly stable PHPT is a risk factor for hip fractures, which adds to other reasons for surgical treatment of this condition without delay regardless of serum calcium levels.     

Osteoporosis in multiple endocrine neoplasia type 1: severity, clinical significance, relationship to primary hyperparathyroidism, and response to parathyroidectomy.

BACKGROUND: Sporadic primary hyperparathyroidism (PHPT) occurs most frequently in postmenopausal women. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal-dominant disease in which mild to moderate PHPT develops in most gene carriers by 20 years of age. Primary hyperparathyroidism associated with MEN 1 is typically recurrent, despite initially successful subtotal parathyroidectomy. Osteoporosis is considered a complication of sporadic PHPT and an indication for parathyroidectomy. In the setting of MEN 1, however, the relationship of bone mass to PHPT, fracture risk, and parathyroidectomy is unknown. HYPOTHESIS: Parathyroidectomy improves bone mineral density for patients with primary hyperparathyroidism in the setting of MEN 1. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Twenty-nine women with MEN 1 belonging to a single family with a history of MEN 1. INTERVENTIONS: Parathyroidectomy. MAIN OUTCOME MEASURES: Bone mineral density (BMD) and history of skeletal fracture. RESULTS: Osteopenia and osteoporosis were diagnosed in 41% and 45% of patients, respectively. Forty-four percent of patients with uncontrolled PHPT had severe osteopenia (T score, <-2.0) by 35 years of age. Reduction in BMD was greatest at the femoral neck. Reduced BMD was associated with an increased likelihood of skeletal fracture (P = .05). Patients with uncontrolled PHPT had lower femoral neck and lumbar spine BMDs than those in whom PHPT was controlled by parathyroidectomy (P = .005 and .02, respectively). Successful parathyroidectomy improved femoral neck and lumbar spine BMDs by a mean +/- SEM of 5.2% +/- 2.5% and 3.2% +/- 2.9%, respectively. CONCLUSIONS: Osteoporosis is a frequent and early complication of PHPT in MEN 1. Despite difficulty in achieving a cure of PHPT in MEN 1, parathyroidectomy has an important role in the optimization of BMD for patients with MEN 1.     

Effects of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism.

In a large proportion of the patients with primary hyperparathyroidism (PHPT), a variable degree of osteopenia is the only relevant manifestation of the disease. Low bone mineral density (BMD) in patients with PHPT is an indication for surgical intervention because successful parathyroidectomy results in a dramatic increase in BMD. However, low BMD values are almost an invariable finding in elderly women with PHPT, who are often either unwilling or considered unfit for surgery. Bisphosphonates are capable of suppressing parathyroid hormone (PTH)-mediated bone resorption and are useful for the prevention and treatment of postmenopausal osteoporosis. In this pilot-controlled study, we investigated the effects of oral treatment with alendronate on BMD and biochemical markers of calcium and bone metabolism in elderly women presenting osteoporosis and mild PHPT. Twenty-six elderly patients aged 67-81 years were randomized for treatment with either oral 10 mg alendronate on alternate-day treatment or no treatment for 2 years. In the control untreated patients a slight significant decrease was observed for total body and femoral neck BMD, without significant changes in biochemical markers of calcium and bone metabolism during the 2 years of observation. Urine deoxypyridinoline (Dpyr) excretion significantly fell within the first month of treatment with alendronate, while serum markers of bone formation alkaline phosphatase and osteocalcin fell more gradually and the decrease became significant only after 3 months of treatment; thereafter all bone turnover markers remained consistently suppressed during alendronate treatment. After 2 years in this group we observed statistically significant increases in BMD at lumbar spine, total hip, and total body (+8.6 +/- 3.0%, +4.8 +/- 3.9%, and +1.2 +/- 1.4% changes vs. baseline mean +/- SD) versus both baseline and control patients. Serum calcium, serum phosphate, and urinary calcium excretion significantly decreased during the first 3-6 months but rose back to the baseline values afterward. Increase in serum PTH level was statistically significant during the first year of treatment. These preliminary results may make alendronate a candidate as a supportive therapy in patients with mild PHPT who are unwilling or are unsuitable for surgery, and for whom osteoporosis is a reason of concern.