Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism

  • W. Wang
  • M. Nie
  • Y. Jiang
  • M. Li
  • X. Meng
  • X. Xing
  • O. WangEmail author
  • W. XiaEmail author
Original Article



This study evaluated bone features of PHPT using HR-pQCT. The results showed both cortical and trabecular bones were significantly impaired in PHPT patients. Male and female PHPT patients suffered similar damages in bone. HR-pQCT indices were not observed to differ in MEN1 and sporadic PHPT patients.


High-resolution peripheral quantitative CT is a novel imaging technique used to separately assess trabecular and cortical bone status of the radius and tibia in vivo. Using HR-pQCT, we aimed to evaluate bone features of primary hyperparathyroidism patients in a Chinese population and reveal similarities and differences in bone features in multiple endocrine neoplasia type 1–related PHPT and sporadic PHPT patients in the Chinese population.


A case-control study was designed. In 58 PHPT patients and 58 sex- and age-matched healthy controls, the distal radius and tibia were scanned using HR-pQCT. Areal bone mineral density (aBMD) was also determined in PHPT patients using dual-energy X-ray absorptiometry (DXA).


In comparison with controls, PHPT patients were observed to exhibit reduced volumetric BMD at the cortical and trabecular compartments, thinner cortices, and more widely spaced trabeculae. Significant differences were still observed when comparing data of female and male patients with age-matched controls separately. MHPT patients (n = 11) were found to have lower aBMD Z-scores in the lumbar spine, trochanteric region, and total hip compared with sporadic PHPT patients (n = 47), while no differences were observed in HR-pQCT indices between the two groups. In multiple linear regression models, no significant correlations were identified between PTH and HR-pQCT indices. However, height was found to positively correlate with HR-pQCT-derived trabecular indices at both the radius and tibia.


PHPT affects geometry, volumetric density, and microstructure in both the cortical and trabecular bones in both male and female Chinese patients. MHPT patients were observed to have reduced aBMD as determined by DXA in the lumbar spine and hip in comparison with sporadic PHPT patients. However, HR-pQCT indices were not observed to differ.


Bone microstructure Bone volumetric density High-resolution peripheral quantitative CT Multiple endocrine neoplasia type 1 Primary hyperparathyroidism 



The authors thank the patients for their participation in the study.

Funding information

This work was financially supported by the Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS-I2M) and the National Natural Science Foundation of China (No. 81100559).

Compliance with ethical standards

The present study was approved by the Ethics Committee of Peking Union Medical College Hospital. Written informed content was obtained from all subjects, and this study was carried out according to the principles defined in the Declaration of Helsinki.

Conflicts of interest


Supplementary material

198_2019_5186_MOESM1_ESM.docx (53 kb)
ESM 1 (DOCX 53 kb)


  1. 1.
    Chen Q, Kaji H, Iu MF et al (2003) Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab 88(10):4655–4658CrossRefGoogle Scholar
  2. 2.
    Silva BC, Costa AG, Cusano NE, Kousteni S, Bilezikian JP (2011) Catabolic and anabolic actions of parathyroid hormone on the skeleton. J Endocrinol Investig 34(10):801–810Google Scholar
  3. 3.
    Dempster DW, Muller R, Zhou H et al (2007) Preserved three-dimensional cancellous bone structure in mild primary hyperparathyroidism. Bone 41(1):19–24CrossRefGoogle Scholar
  4. 4.
    Minisola S, Rosso R, Romagnoli E et al (2002) Uneven deficits in vertebral bone density in postmenopausal patients with primary hyperparathyroidism as evaluated by posterior-anterior and lateral dual-energy absorptiometry. Osteoporos Int 13(8):618–623CrossRefGoogle Scholar
  5. 5.
    Parisien M, Silverberg SJ, Shane E et al (1990) The histomorphometry of bone in primary hyperparathyroidism: preservation of cancellous bone structure. J Clin Endocrinol Metab 70(4):930–938CrossRefGoogle Scholar
  6. 6.
    Christiansen P, Steiniche T, Brockstedt H, Mosekilde L, Hessov I, Melsen F (1993) Primary hyperparathyroidism: iliac crest cortical thickness, structure, and remodeling evaluated by histomorphometric methods. Bone 14(5):755–762CrossRefGoogle Scholar
  7. 7.
    Uchiyama T, Tanizawa T, Ito A, Endo N, Takahashi HE (1999) Microstructure of the trabecula and cortex of iliac bone in primary hyperparathyroidism patients determined using histomorphometry and node-strut analysis. J Bone Miner Metab 17(4):283–288CrossRefGoogle Scholar
  8. 8.
    Khosla S, Melton LR, Wermers RA, Crowson CS, O’Fallon W, Riggs B (1999) Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res 14(10):1700–1707CrossRefGoogle Scholar
  9. 9.
    Hansen S, Beck JJ, Rasmussen L, Hauge EM, Brixen K (2010) Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: a case-control study using HR-pQCT. J Bone Miner Res 25(9):1941–1947CrossRefGoogle Scholar
  10. 10.
    Stein EM, Silva BC, Boutroy S et al (2013) Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women. J Bone Miner Res 28(5):1029–1040CrossRefGoogle Scholar
  11. 11.
    Vu TD, Wang XF, Wang Q et al (2013) New insights into the effects of primary hyperparathyroidism on the cortical and trabecular compartments of bone. Bone 55(1):57–63CrossRefGoogle Scholar
  12. 12.
    Hansen S, Hauge EM, Rasmussen L, Jensen JE, Brixen K (2012) 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. J Bone Miner Res 27(5):1150–1158CrossRefGoogle Scholar
  13. 13.
    Bilezikian JP, Meng X, Shi Y, Silverberg SJ (2000) Primary hyperparathyroidism in women: a tale of two cities—New York and Beijing. Int J Fertil Womens Med 45(2):158–165PubMedGoogle Scholar
  14. 14.
    Boutroy S, Walker MD, Liu XS et al (2014) Lower cortical porosity and higher tissue mineral density in Chinese American versus white women. J Bone Miner Res 29(3):551–561CrossRefGoogle Scholar
  15. 15.
    Walker MD, Liu XS, Stein E et al (2011) Differences in bone microarchitecture between postmenopausal Chinese-American and white women. J Bone Miner Res 26(7):1392–1398CrossRefGoogle Scholar
  16. 16.
    Thakker RV et al (2012) Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab 97(9):2990–3011CrossRefGoogle Scholar
  17. 17.
    Thakker RV, Newey PJ, Walls GV et al (2009) Sporadic and MEN1-related primary hyperparathyroidism: differences in clinical expression and severity. J Bone Miner Res 24(8):1404–1410CrossRefGoogle Scholar
  18. 18.
    Kong J, Wang O, Nie M et al (2016) Clinical and genetic analysis of multiple endocrine neoplasia type 1-related primary hyperparathyroidism in Chinese. PLoS One 11(11):e0166634CrossRefGoogle Scholar
  19. 19.
    Lourenco DJ, Toledo RA, Mackowiak II et al (2008) Multiple endocrine neoplasia type 1 in Brazil: MEN1 founding mutation, clinical features, and bone mineral density profile. Eur J Endocrinol 159(3):259–274CrossRefGoogle Scholar
  20. 20.
    Lourenco DJ, Coutinho FL, Toledo RA, Montenegro FL, Correia-Deur JE, Toledo SP (2010) Early-onset, progressive, frequent, extensive, and severe bone mineral and renal complications in multiple endocrine neoplasia type 1-associated primary hyperparathyroidism. J Bone Miner Res 25(11):2382–2391CrossRefGoogle Scholar
  21. 21.
    Yu W, Qin MW, Xu L (1996) Bone mineral analysis of 445 normal subjects assessed by dual X-ray absorptiometry. Chin J Rad 30:625–629Google Scholar
  22. 22.
    Pauchard Y, Liphardt AM, Macdonald HM, Hanley DA, Boyd SK (2012) Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone 50(6):1304–1310CrossRefGoogle Scholar
  23. 23.
    Kim CH, Takai E, Zhou H et al (2003) Trabecular bone response to mechanical and parathyroid hormone stimulation: the role of mechanical microenvironment. J Bone Miner Res 18(12):2116–2125CrossRefGoogle Scholar
  24. 24.
    Hagino H, Okano T, Akhter MP, Enokida M, Teshima R (2001) Effect of parathyroid hormone on cortical bone response to in vivo external loading of the rat tibia. J Bone Miner Metab 19(4):244–250CrossRefGoogle Scholar
  25. 25.
    Mazeh H, Sippel RS, Chen H (2012) The role of gender in primary hyperparathyroidism: same disease, different presentation. Ann Surg Oncol 19(9):2958–2962CrossRefGoogle Scholar
  26. 26.
    Shah VN, Bhadada SK, Bhansali A, Behera A, Mittal BR, Bhavin V (2012) Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 58(2):107–111CrossRefGoogle Scholar
  27. 27.
    De Lucia F, Minisola S, Romagnoli E et al (2013) Effect of gender and geographic location on the expression of primary hyperparathyroidism. J Endocrinol Investig 36(2):123–126Google Scholar
  28. 28.
    Kann PH, Bartsch D, Langer P et al (2012) Peripheral bone mineral density in correlation to disease-related predisposing conditions in patients with multiple endocrine neoplasia type 1. J Endocrinol Investig 35(6):573–579Google Scholar
  29. 29.
    Ghasem-Zadeh A, Burghardt A, Wang XF et al (2017) Quantifying sex, race, and age specific differences in bone microstructure requires measurement of anatomically equivalent regions. Bone 101:206–213CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingPeople’s Republic of China
  2. 2.Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe HospitalCapital Medical UniversityBeijingPeople’s Republic of China

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