Regression of skeletal manifestations of hyperparathyroidism with oral vitamin D

Asma Arabi; Nabil Khoury; Laila Zahed; Adel Birbari; Ghada El-Hajj Fuleihan

doi:10.1210/jc.2005-2518

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Regression of skeletal manifestations of hyperparathyroidism with oral vitamin D

Journal article

Open access

Peer reviewed

Regression of skeletal manifestations of hyperparathyroidism with oral vitamin D

Asma Arabi, Nabil Khoury, Laila Zahed, Adel Birbari and Ghada El-Hajj Fuleihan

The journal of clinical endocrinology and metabolism, Vol.91(7), pp.2480-2483

07/2006

DOI: 10.1210/jc.2005-2518

PMID: 16608887

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Abstract

Parathyroidectomy is the only effective therapy for osteitis fibrosa cystica in hyperparathyroidism. The objective of this study was to describe the changes of skeletal and nonskeletal manifestations in a patient with hyperparathyroidism and renal failure after oral vitamin D therapy. This was a descriptive case report. The patient was followed up in a referral center. A 55-yr-old male patient with moderate renal failure was referred for expansile lytic lesions affecting several ribs and the spinous process of T12. His creatinine was 1.8 mg/dl; calcium, 8.9 mg/dl; PTH, 666 pg/ml; and 1,25 dihydroxy-vitamin D, 27 pg/ml. Bone mineral density (BMD) Z-scores by dual-energy x-ray absorptiometry were -4.1 at the spine, -1.7 at the hip, and -4.3 at the forearm. The main outcome measures were the skeletal manifestations of hyperparathyroidism. At 10 months of therapy, calcium level was 10 mg/d, PTH level declined to 71 pg/ml, and BMD increased by 12% at the spine and 18% at the hip. Computerized tomography (CT) cuts revealed marked regression in the lytic lesions. At 2 yr, BMD increased by an additional 6% at the spine, and there were no further changes in the lytic lesions by CT. The vitamin D receptor genotype using the restriction enzymes Bsm1, Taq1, and Apa1 was Bb, tt, and AA. We showed regression of severe skeletal abnormalities of hyperparathyroidism documented by serial CT images in response to oral vitamin D therapy. It is possible that the vitamin D receptor genotype of the patient modulated this response.

Bone Density

Bone Diseases - diagnosis

Bone Diseases - drug therapy

Bone Diseases - etiology

Calcium - blood

Calcium - urine

Cholecalciferol - administration & dosage

Genotype

Humans

Hydroxycholecalciferols - administration & dosage

Hyperparathyroidism, Secondary - complications

Hyperparathyroidism, Secondary - drug therapy

Kidney Failure, Chronic - complications

Male

Middle Aged

Osteitis Fibrosa Cystica - diagnosis

Osteitis Fibrosa Cystica - drug therapy

Osteitis Fibrosa Cystica - etiology

Osteoporosis - diagnosis

Osteoporosis - drug therapy

Osteoporosis - etiology

Receptors, Calcitriol - genetics

Thalassemia - complications

Tomography, X-Ray Computed

Vitamin D - therapeutic use

Details

Title: Subtitle: Regression of skeletal manifestations of hyperparathyroidism with oral vitamin D
Creators: Asma Arabi - American University of Beirut Medical Center
Nabil Khoury
Laila Zahed - American University of Beirut Medical Center
Adel Birbari
Ghada El-Hajj Fuleihan
Resource Type: Journal article
Publication Details: The journal of clinical endocrinology and metabolism, Vol.91(7), pp.2480-2483
DOI: 10.1210/jc.2005-2518
PMID: 16608887
ISSN: 0021-972X
eISSN: 1945-7197
Language: English
Date published: 07/2006
Academic Unit: Radiology
Record Identifier: 9984697727102771

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