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Endocrine Abstracts (2022) 81 OC8.3 | DOI: 10.1530/endoabs.81.OC8.3

ECE2022 Oral Communications Oral Communications 8: Calcium and Bone (6 abstracts)

Impact of preoperative zoledronic acid on hungry bone syndrome and bone health indices in patients with primary hyperparathyroidism after curative parathyroidectomy: a randomized controlled trial

Akanksha Gautam 1 , Sanjay Bhadada 2 , Anil Bhansali 2 , Divya Dahiya 3 , Arunanshu Behera 3 , Uma Nahar Saikia 4 , Ashwani Sood 5 & Tulika Singh 6


1Post Graduate Institute of Medical Education & Research, Chandigarh, Endocrinology, Chandigarh, India; 2Post Graduate Institute of Medical Education & Research, Chandigarh, Endocrinology, Chandigarh, India; 3Post Graduate Institute of Medical Education & Research, Chandigarh, Surgery, Chandigarh, India; 4Post Graduate Institute of Medical Education & Research, Chandigarh, Histopathology, Chandigarh, India; 5Post Graduate Institute of Medical Education & Research, Chandigarh, Nuclear Medicine, Chandigarh, India; 6Post Graduate Institute of Medical Education & Research, Chandigarh, Radiodiagnosis, Chandigarh, India


Background: In individuals with primary hyperparathyroidism (PHPT), the utility of preoperative bisphosphonate administration in prevention of post-curative-parathyroidectomy hungry bone syndrome (HBS) and effects on long-term bone accrual are uncertain.

Objectives: To estimate the effect of preoperative administration of single infusion of zoledronic acid (ZA) on occurrence of HBS and gain in bone mineral density (BMD) at one year in individuals with PHPT undergoing curative parathyroidectomy.

Methods: In this single-centre, randomized (1:1), single-blind, placebo-controlled study (CTRI/2019/10/021762), a total of 48 adults (age > 18 years) with PHPT (serum Calcium ≥ 11 mg/dl) were enrolled. Prior to parathyroidectomy (≤ 2 weeks), participants received either a single intravenous infusion of 5 mg ZA (n=24) or placebo (n=24). Post-curative-parathyroidectomy, participants were monitored for occurrence of HBS until discharge. HBS was defined by the presence of hypocalcemia (Ca< 8.5 mg/dl) and hypophosphatemia (P< 2.7 mg/dl) with rise in alkaline phosphatase (ALP) (>5%) on any day after surgery. BMD (Hologic Discovery 4500) and trabecular bone score (TBS) were assessed at baseline and one year after surgery. In addition, bone turnover markers (CTX, P1NP) were assessed at baseline, first week, 3-, 9- and 12- months post-surgery. Occurrence of HBS was assessed using binary logistic regression model. Changes in BMD and BTM were assessed using linear mixed model for repeated measures.

Results: Forty five out of 48 participants had succesful curative parathyroidectomy. HBS occured in 6 (27.3%) individuals in ZA and 6 (26.1%) in placebo group [OR: 1.06 (0.28 - 3.98);P=0.928]. The odds for developing HBS were comparable after adjusting for baseline severity and serum 25(OH)D levels (P=0.075). Individuals in ZA group had a higher gain in BMD at lumbar spine (7.54%; 95% CI, 0.06 to 15.02; P=0.048), comparable gain at neck of femur (9.74%; 95% CI, - 5.005 to 24.49; P= 0.190) and a fall in BMD at distal radius (3.29% ; 95% CI, -10.17 to 2.31; P=0.008). Rise in TBS was comparable between the two groups (P=0.396). The higher gain in BMD at lumbar spine was paralleled by a higher decline in CTX (27.8%; 95% CI, -48.44 to -7.12; P=0.009) in ZA group while ALP (10.9%; 95% CI, -23.39 to 1.44; P=0.082) and P1NP levels remained comparable (9.50%; 95% CI, -22.36 to 41.37; P=0.360).

Conclusion: In PHPT, preoperative administration of single infusion of ZA is associated with increased bone mineral accrual at lumbar spine without significant effect on occurrence of HBS.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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