Treatment Analysis Of Skeletal Lesions Secondary To Primary Hyperparathyroidism

Background:Osteitis fibrosa cystica (OFC) has a relatively low morbidity and is apt to be misdiagnosed to be neoplasm. In fact, it is compensatory skeletal disorder caused by surplus of parathyroid hormone. The overactivity and proliferation of osteoclasts stimulated by PTH break down bone and result in replacement of bone matrix and thinning of cortex."Brown tumor" is named by brown hemosiderin deposition in the cystic defects. Majority of primary hyperparathyroidism (PHPT) is parathyroid adenoma (80%-85%) and the parathyroid carcinoma is less than0.5%-4%. The OFC is often easy to be misdiagnosed due to lack of specificity in radiography and histology. Parathyroidectomy (PTX) has been well known to be effective. However, there is still dispute to whether the orthopedic operation should be undertaken.Objectives:To discuss the pathogenesis, clinical manifestation, biochemical screenings, radiological examinations, treatment means and operation indication of osteitis fibrosa cystica (OFC). To avoid misdiagnosis, delay treatment and overtreatment and meanwhile to provide the clinical guidance to the comprehensive therapy of OFC.Methods:Eight patients from Qilu Hospital of Shandong University who suffer from osteitis fibrosa cystica caused by primary hyperparathyroidism (PHPT). Meanwhile the clinical manifestations, biochemical and radiography examinations, operations and prognosis are reported.Results:Five cases complaint malaise with bone pain (62.5%) and three cases were admitted because of pathological fracture with minor force (37.5%). The age is28-55years, average42years. Biochemical screening showed hypercalcemia and high PTH in varying extents (100%). And the serum calcium elevated with mean concentration of3.26mmol/L (range,2.66～3.72mmol/L). The mean value of parathyroid hormone (PTH) was of1058g/ml (range,99～2261g/ml). Lytic lesions or diffuse osteoporosis could be seen in the radiology including3cases brown tumor (37.5%)and5cases other bone tumors (62.5%). The bone diseases presented a spontaneous regression in different period following parathyroidectomy in every patient(100%). Four cases underwent orthopedic procedures (50%) and bone biopsies were made among these2cases were misdiagnosed to be bone cyst and simple fracture (25%). The regression of PTH and calcium is obviously earlier than the bone lesions. The bone mineral destiny (BMD) can be regressed from3months after parathyroidectomy.Conclusions:The OFC is often easy to be misdiagnosed in orthopedic department due to lack of specificity in radiography and histology. The right diagnosis requires combination of clinical manifestations, routine biochemical screenings, radiography examinations of bone and parathyroid, and bone biopsy in necessity. Parathyroidectomy has been effective. Sometimes orthopedic operation intervention is necessary after a correct diagnosis and parathyroidectomy. Even so, the indications of orthopedic operations must be controlled strictly to avoid overtreatment.