Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism / 中华内分泌外科杂志

ABSTRACT

Objective:To determine possible risk factors of developing HBS after parathyroidectomy for PHPT.Methods:The clinical data of 104 patients with PHPT who were hospitalized in the First Affiliated Hospital of Chongqing Medical University and underwent PTX surgery from Apr. 2014 to Apr. 2022 were retrospectively analyzed.There were 36 males and 68 females. 105 patient were divided into two groups: HBS group ( n=29) and non-HBS group ( n=75) according to whether HBS occurred after PTX. The clinical related data of the two groups were collected and analyzed with SPSS 22.0 software to determine the risk factors of HBS. Results:Serum albumin, blood magnesium, blood phosphorus, 25 (OH) D and hip bone mineral density in HBS group were lower than those in non HBS group; Preoperative blood calcium, blood PTH, bone turnover markers (BALP, OC, PINP β- CTX) were higher than those in non HBS group ( P<0.05). The preoperative serum calcium, BALP, and PINP levels in the HBS group and non HBS group were: (3.37±0.58) vs (2.91±0.28) mmol/L; 38.37 (15.59, 58.79) vs 18.21 (11.28, 25.57) μg/L; 256.25 (139.95, 527.95) vs 79.72 (50.64, 120.33) ng/ml. Preoperative serum calcium ( OR=15.006, P<0.001), PTH ( OR=1.002, P<0.001), BALP ( OR=1.055, P<0.001), OC ( OR=1.019, P<0.001), PINP ( OR=1.008, P<0.001), β-CTX ( OR=1.816, P=0.006) were positively correlated with HBS, while serum albumin ( OR=0.850, P=0.011), magnesium ( OR=0.012, P=0.002), 25 (OH) D ( OR=0.844, P=0.001) and hip BMD ( OR=0.00, P=0.019) were negatively correlated with HBS. Preoperative serum calcium ( OR=36.689, P=0.009), PINP ( OR=1.019, P=0.022) and BALP ( OR=1.049, P=0.031) were independent risk factors for HBS. The ROC curves showed that the AUC values were 0.7368, 0.8326, and 0.7605, respectively, with sensitivities of 55.2%, 75.9%, and 72.4%; the specificities were 88.0%, 81.3% and 78.7%. The amount of intravenous calcium supplement in HBS patients was related to preoperative blood BALP and PINP ( P=0.035) . Conclusions:Patients with PHPT have a significantly increased risk of postoperative HBS when preoperative blood calcium>3.22 mmol/L, P1N P>138.80 ng/ml, or BAL P>26.08 (μg/L). For patients with significantly elevated preoperative blood P1NP, postoperative calcium supplementation can be appropriately increased.