Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism

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Abstract

with primary aldosteronism (PA) due to secondary hyperparathyroidism. Our objective is to assess bone turnover markers (BTM) and bone mineral density (BMD) of PApatients compared to essential hypertension. METHODS: This was an open-label, prospective, case-controlled study, conducted over 12 months. Fifty-two consecutive patients referred for secondary hypertension were screened. Eighteen patients with confirmed PA (diagnosis based on the Endocrine Society clinical guideline) and seventeen matched controls with essential hypertension were recruited. BTM (CTX and P1NP), BMD, intact parathyroid hormone (iPTH), and bone profile were assessed at baseline and three months following treatment among the PApatients. Calcium intake was assessed using a validated questionnaire. Primary outcomes were the changes of bone markers and BMDfollowing treatment of PA, and their relation to other parameters. RESULTS: PA patients had significantly lower serum calcium and higher iPTH despite comparable Vitamin D levels with control group. Both BTM were significantly higher among the PA group. BMD of lumbar spine, neck of femur and distal radius did not differ between groups. Three months following treatment, there were significant: 1) reduction in BTM; 2) improvement in the lumbar spine BMD; 3) reduction in iPTH level; and 4) increment of serum 25-OH Vitamin Dlevel. CONCLUSIONS: Our findings support that bone loss and potential fracture risk among PA patients are likely a result of aldosterone-mediated secondary hyperparathyroidism. Patients with early PAmay already exhibit increased bone turnover despite no significant changes in BMD.

Original languageEnglish
Pages (from-to)117-125
Number of pages9
JournalMinerva Endocrinologica
Volume43
Issue number2
DOIs
Publication statusPublished - 1 Jun 2018
Externally publishedYes

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Hyperaldosteronism
Bone Remodeling
Bone Density
Bone and Bones
Parathyroid Hormone
Secondary Hyperparathyroidism
Spine
Therapeutics
Calcium
Femur Neck
Aldosterone
Serum
Vitamin D
Vitamins
Guidelines
Hypertension
Control Groups

Keywords

  • Key words: bone remodeling - bone density - osteoporosis - hyperaldosteronism - hyperparathyroidism

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

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title = "Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism",
abstract = "with primary aldosteronism (PA) due to secondary hyperparathyroidism. Our objective is to assess bone turnover markers (BTM) and bone mineral density (BMD) of PApatients compared to essential hypertension. METHODS: This was an open-label, prospective, case-controlled study, conducted over 12 months. Fifty-two consecutive patients referred for secondary hypertension were screened. Eighteen patients with confirmed PA (diagnosis based on the Endocrine Society clinical guideline) and seventeen matched controls with essential hypertension were recruited. BTM (CTX and P1NP), BMD, intact parathyroid hormone (iPTH), and bone profile were assessed at baseline and three months following treatment among the PApatients. Calcium intake was assessed using a validated questionnaire. Primary outcomes were the changes of bone markers and BMDfollowing treatment of PA, and their relation to other parameters. RESULTS: PA patients had significantly lower serum calcium and higher iPTH despite comparable Vitamin D levels with control group. Both BTM were significantly higher among the PA group. BMD of lumbar spine, neck of femur and distal radius did not differ between groups. Three months following treatment, there were significant: 1) reduction in BTM; 2) improvement in the lumbar spine BMD; 3) reduction in iPTH level; and 4) increment of serum 25-OH Vitamin Dlevel. CONCLUSIONS: Our findings support that bone loss and potential fracture risk among PA patients are likely a result of aldosterone-mediated secondary hyperparathyroidism. Patients with early PAmay already exhibit increased bone turnover despite no significant changes in BMD.",
keywords = "Key words: bone remodeling - bone density - osteoporosis - hyperaldosteronism - hyperparathyroidism",
author = "Loh, {Huai H.} and Kamaruddin, {Nor Azmi} and Rozman Zakaria and Norlela Sukor",
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AU - Loh, Huai H.

AU - Kamaruddin, Nor Azmi

AU - Zakaria, Rozman

AU - Sukor, Norlela

PY - 2018/6/1

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N2 - with primary aldosteronism (PA) due to secondary hyperparathyroidism. Our objective is to assess bone turnover markers (BTM) and bone mineral density (BMD) of PApatients compared to essential hypertension. METHODS: This was an open-label, prospective, case-controlled study, conducted over 12 months. Fifty-two consecutive patients referred for secondary hypertension were screened. Eighteen patients with confirmed PA (diagnosis based on the Endocrine Society clinical guideline) and seventeen matched controls with essential hypertension were recruited. BTM (CTX and P1NP), BMD, intact parathyroid hormone (iPTH), and bone profile were assessed at baseline and three months following treatment among the PApatients. Calcium intake was assessed using a validated questionnaire. Primary outcomes were the changes of bone markers and BMDfollowing treatment of PA, and their relation to other parameters. RESULTS: PA patients had significantly lower serum calcium and higher iPTH despite comparable Vitamin D levels with control group. Both BTM were significantly higher among the PA group. BMD of lumbar spine, neck of femur and distal radius did not differ between groups. Three months following treatment, there were significant: 1) reduction in BTM; 2) improvement in the lumbar spine BMD; 3) reduction in iPTH level; and 4) increment of serum 25-OH Vitamin Dlevel. CONCLUSIONS: Our findings support that bone loss and potential fracture risk among PA patients are likely a result of aldosterone-mediated secondary hyperparathyroidism. Patients with early PAmay already exhibit increased bone turnover despite no significant changes in BMD.

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