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Archives of Endocrinology and Metabolism Nov 2022Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is... (Review)
Review
Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.
Topics: Humans; Calcium; Quality of Life; Hypoparathyroidism; Bone Density; Vitamin D; Parathyroid Hormone
PubMed: 36382753
DOI: 10.20945/2359-3997000000553 -
Endocrinology and Metabolism Clinics of... Jun 2017Primary hyperparathyroidism (HPT) is a metabolic disease caused by the excessive secretion of parathyroid hormone from 1 or more neoplastic parathyroid glands. HPT is... (Review)
Review
Primary hyperparathyroidism (HPT) is a metabolic disease caused by the excessive secretion of parathyroid hormone from 1 or more neoplastic parathyroid glands. HPT is largely sporadic, but it can be associated with a familial syndrome. The study of such families led to the discovery of tumor suppressor genes whose loss of function is now recognized to underlie the development of many sporadic parathyroid tumors. Heritable and acquired oncogenes causing parathyroid neoplasia are also known. Studies of somatic changes in parathyroid tumor DNA and investigation of kindreds with unexplained familial HPT promise to unmask more genes relevant to parathyroid neoplasia.
Topics: Humans; Hyperparathyroidism; Parathyroid Neoplasms
PubMed: 28476229
DOI: 10.1016/j.ecl.2017.01.006 -
Australian Journal of General Practice 2023Chronic kidney disease mineral and bone disorder (CKD-MBD) is an important cause of morbidity, cardiovascular risk and mortality among patients with chronic kidney... (Review)
Review
BACKGROUND
Chronic kidney disease mineral and bone disorder (CKD-MBD) is an important cause of morbidity, cardiovascular risk and mortality among patients with chronic kidney disease (CKD). The condition begins to manifest in stage 3a CKD. General practitioners play a crucial part in screening, monitoring and early management of this important problem, which is primarily managed in the community.
OBJECTIVE
The aim of this article is to summarise the key evidence-based principles of the pathogenesis, assessment and management of CKD-MBD.
DISCUSSION
CKD-MBD includes a spectrum of disease involving biochemical changes, bone abnormalities and vascular and soft tissue calcification. Management is centred on monitoring and controlling biochemical parameters with a variety of strategies to improve bone health and cardiovascular risk. The range of evidence-based treatment options is reviewed in this article.
Topics: Humans; Chronic Kidney Disease-Mineral and Bone Disorder; Parathyroid Hormone; Renal Insufficiency, Chronic; General Practice
PubMed: 36796773
DOI: 10.31128/AJGP-03-22-6365 -
Journal of the American Society of... Nov 2020
Topics: Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Parathyroid Hormone; Phosphates; Renal Insufficiency, Chronic
PubMed: 32931449
DOI: 10.1681/ASN.2020081182 -
International Journal of Molecular... Nov 2021The advent of new insights into phosphate metabolism must urge the endocrinologist to rethink the pathophysiology of widespread disorders, such as primary... (Review)
Review
The advent of new insights into phosphate metabolism must urge the endocrinologist to rethink the pathophysiology of widespread disorders, such as primary hyperparathyroidism, and also of rarer endocrine metabolic bone diseases, such as hypoparathyroidism and tumor-induced hypophosphatemia. These rare diseases of mineral metabolism have been and will be a precious source of new information about phosphate and other minerals in the coming years. The parathyroid glands, the kidneys, and the intestine are the main organs affecting phosphate levels in the blood and urine. Parathyroid disorders, renal tubule defects, or phosphatonin-producing tumors might be unveiled from alterations of such a simple and inexpensive mineral as serum phosphate. This review will present all these disorders from a 'phosphate perspective'.
Topics: Bone and Bones; Calcium; Humans; Hyperparathyroidism, Primary; Hypoparathyroidism; Hypophosphatemia; Multiple Endocrine Neoplasia; Osteomalacia; Parathyroid Diseases; Parathyroid Glands; Phosphates
PubMed: 34884774
DOI: 10.3390/ijms222312975 -
Calcified Tissue International Apr 2021Chronic kidney diseases (CKD) are associated with mineral and bone diseases (MBD), including pain, bone loss, and fractures. Bone fragility related to CKD includes the... (Review)
Review
Chronic kidney diseases (CKD) are associated with mineral and bone diseases (MBD), including pain, bone loss, and fractures. Bone fragility related to CKD includes the risk factors observed in osteoporosis in addition to those related to CKD, resulting in a higher risk of mortality related to fractures. Unawareness of such complications led to a poor management of fractures and a lack of preventive approaches. The current guidelines of the Kidney Disease Improving Global Outcomes (KDIGO) recommend the assessment of bone mineral density if results will impact treatment decision. In addition to bone density, circulating biomarkers of mineral, serum bone turnover markers, and imaging techniques are currently available to evaluate the fracture risk. The purpose of this review is to provide an overview of the epidemiology and pathogenesis of CKD-associated bone loss. The contribution of the current tools and other techniques in development are discussed. We here propose a current view of how to better predict bone fragility and the therapeutic options in CKD.
Topics: Bone Density; Chronic Kidney Disease-Mineral and Bone Disorder; Fractures, Bone; Humans; Osteoporosis; Renal Insufficiency, Chronic
PubMed: 33219822
DOI: 10.1007/s00223-020-00779-z -
Hormone and Metabolic Research =... Aug 2020Calcium homeostasis is maintained by the actions of the parathyroid glands, which release parathyroid hormone into the systemic circulation as necessary to maintain the... (Review)
Review
Calcium homeostasis is maintained by the actions of the parathyroid glands, which release parathyroid hormone into the systemic circulation as necessary to maintain the serum calcium concentration within a tight physiologic range. Excessive secretion of parathyroid hormone from one or more neoplastic parathyroid glands, however, causes the metabolic disease primary hyperparathyroidism (HPT) typically associated with hypercalcemia. Although the majority of cases of HPT are sporadic, it can present in the context of a familial syndrome. Mutations in the tumor suppressor genes discovered by the study of such families are now recognized to be pathogenic for many sporadic parathyroid tumors. Inherited and somatic mutations of proto-oncogenes causing parathyroid neoplasia are also known. Future investigation of somatic changes in parathyroid tumor DNA and the study of kindreds with HPT yet lacking germline mutation in the set of genes known to predispose to HPT represent two avenues likely to unmask additional novel genes relevant to parathyroid neoplasia.
Topics: Genetic Predisposition to Disease; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Mutation; Prognosis; Tumor Suppressor Proteins
PubMed: 32227318
DOI: 10.1055/a-1132-6223 -
Renal Failure Dec 2023The assessment and prevention of mineral and bone disorder (MBD) in kidney transplant recipients (KTRs) have not been standardized. This study aimed to evaluate MBD one...
BACKGROUND
The assessment and prevention of mineral and bone disorder (MBD) in kidney transplant recipients (KTRs) have not been standardized. This study aimed to evaluate MBD one year after kidney transplantation (KT) and identify the influencing factors of MBD.
METHODS
A total of 95 KTRs in our center were enrolled. The changes in bone mineral density (BMD) and bone metabolism biochemical markers, including serum calcium (Ca), phosphorus(P), 25-hydroxyvitamin D(25(OH)vitD), intact parathyroid hormone (iPTH), bone alkaline phosphatase, osteocalcin (OC), type I collagen N-terminal peptide and type I collagen C-terminal peptide (CTx), over one year after KT were assessed. The possible influencing factors of BMD were analyzed. The relationships between bone metabolism biochemical markers were evaluated. The indicators between groups with or without iPTH normalization were also compared.
RESULTS
MBD after KT was manifested as an increased prevalence of hypophosphatemia and bone loss, persistent 25(OH)vitD deficiency, and partially decreased PTH and bone turnover markers (BTMs). Femoral neck BMD was positively correlated with body mass index (BMI) and postoperative 25(OH)vitD, and negatively correlated with postoperative PTH. Lumbar spine BMD was positively correlated with BMI and preoperative TG, and negatively correlated with preoperative OC and CTx. BMD loss was positively associated with glucocorticoid accumulation. Preoperative and postoperative iPTH was negatively correlated with postoperative serum P and 25(OH)vitD, and positively correlated with postoperative Ca and BTMs. The recipients without iPTH normalization, who accounted for 41.0% of all KTRs, presented with higher Ca, lower P, higher BTMs, advanced age, and a higher prevalence of preoperative parathyroid hyperplasia.
CONCLUSIONS
MBD persisted after KT, showing a close relationship with hyperparathyroidism, high bone turnover, and glucocorticoid accumulation.
Topics: Humans; Biomarkers; Bone Density; Bone Remodeling; Cohort Studies; Collagen Type I; Glucocorticoids; Kidney Transplantation; Parathyroid Hormone; Peptides; Hyperparathyroidism; Chronic Kidney Disease-Mineral and Bone Disorder; Osteoporosis
PubMed: 37183797
DOI: 10.1080/0886022X.2023.2210231 -
Jornal Brasileiro de Nefrologia 2018Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its... (Review)
Review
Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance. Bone biopsy has also been recommended for evaluation of osteoporosis in the CKD setting to help physicians choose the best anti-osteoporotic drug. Importantly, bone biopsy is the sole diagnostic method capable of providing dynamic information on bone metabolism. Trabecular and cortical bones may be analyzed separately by evaluating their structural and dynamic parameters, thickness and porosity, respectively. Deposition of metals, such as aluminum and iron, on bone may also be detected. Despite of these unique characteristics, the interest on bone biopsy has declined over the last years and there are currently few centers around the world specialized on bone histomorphometry. In this review, we will discuss the bone biopsy technique, its indications, and the main information it can provide. The interest on bone biopsy should be renewed and nephrologists should be capacitated to perform it as part of their training during medical residency.
Topics: Biopsy; Bone and Bones; Chronic Kidney Disease-Mineral and Bone Disorder; Equipment Design; Humans; Nephrology; Practice Patterns, Physicians'
PubMed: 30525179
DOI: 10.1590/2175-8239-jbn-2017-0012 -
Endocrinology and Metabolism Clinics of... Dec 2018Hypoparathyroidism is characterized by hypocalcemia and hyperphosphatemia and is due to insufficient levels of circulating parathyroid hormone. Hypoparathyroidism may be... (Review)
Review
Hypoparathyroidism is characterized by hypocalcemia and hyperphosphatemia and is due to insufficient levels of circulating parathyroid hormone. Hypoparathyroidism may be an isolated condition or a component of a complex syndrome. Although genetic disorders are not the most common cause of hypoparathyroidism, molecular analyses have identified a growing number of genes that when defective result in impaired formation of the parathyroid glands, disordered synthesis or secretion of parathyroid hormone, or postnatal destruction of the parathyroid glands.
Topics: Humans; Hypoparathyroidism; Parathyroid Diseases; Parathyroid Glands; Parathyroid Hormone
PubMed: 30390815
DOI: 10.1016/j.ecl.2018.07.007