Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus.

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations.

The association between vitamin D receptor gene polymorphisms (TaqI and FokI), Type 2 diabetes, and micro-/macrovascular complications in postmenopausal women.

Introduction: Since there is evidence of the action of vitamin D as a modulator of insulin release and atherosclerosis, it may well be that the vitamin D receptor polymorphisms are associated with diabetes and its chronic complications.

Aims: To examine the associations between vitamin D receptor polymorphisms (FokI and TaqI) and Type 2 diabetes (T2DM) and its associated chronic complications in postmenopausal women.

Methods: This cross-sectional study analyzed 100 postmenopausal women with T2DM (mean age 65.

Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis.

Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.

The effects of intermittent vitamin D3 supplementation on muscle strength and metabolic parameters in postmenopausal women with type 2 diabetes: a randomized controlled study.

Background: The aim of this study was to evaluate the effect of weekly vitamin D3 supplementation on metabolic parameters and muscle strength of postmenopausal women with type 2 diabetes.

Methods: A total of 38 patients with serum 25-hydroxy vitamin D [25(OH)D] below 30 ng/ml and hand strength below 20 kg were randomly assigned to oral vitamin D3 (6600 IU/week in 2 cc oil preparation) or 2 cc olive oil weekly for 3 months.

Results: There were nonsignificant increases in serum 25(OH)D in the intervention group to 22.

Hyperparathyroidism and Bone Health.

Bone pain, proximal muscle weakness, skeletal deformities, and pathological fractures are features of osteitis fibrosa cystica which occur in severe primary hyperparathyroidism (PHPT). In this condition, bone mineral density is usually extremely low, but may be reversible after parathyroidectomy. On X-ray, bone abnormalities are described as having a salt-and-pepper appearance in the skull, with bone erosions and resorption of the phalanges, brown tumors and cysts, as well as diffuse demineralization, along with pathological fractures, particularly in the long bones of the extremities.

Prevalence of Orthostatic Hypertension in Elderly Patients with Type 2 Diabetes.

Background. The aim of the present study was to determine the prevalence of orthostatic hypertension (OHT) in elderly patients with type 2 diabetes and its relation to metabolic and echocardiographic parameters. Methods.

Ethnic aspects of vitamin D deficiency.

Vitamin D deficiency has been linked to bone fragility in children and adults, and to an increased risk of chronic diseases. The main sources of vitamin D are the diet and cutaneous synthesis, the latter being the most important one, since foods are relatively poor in vitamin D. The main factors influencing this endogenous production are the seasons, the time of day, latitude and skin phototype.

Bone markers and osteoporosis therapy.

Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss.

Prevalence of morphometric vertebral fractures in old men and the agreement between different methods in the city of Recife, Brazil.

Osteoporosis is relatively common in men and has a great impact on quality of life. Despite the importance of the subject, there are few studies regarding the prevalence of morphometric vertebral fractures in men and the associated risk factors. To determine the prevalence of morphometric vertebral fractures in elderly men by three different methods and the agreement between them, 234 asymptomatic men aged >60 years (mean age 69.

Epidemiology of Primary Hyperparathyroidism and its Non-classical Manifestations in the City of Recife, Brazil.

Before the introduction of routine measurements of serum calcium in ambulatory services, PHTP (primary hyperparathyroidism) was symptomatic with classic bone disease (known as osteitis fibrosa cystica) nephrolithiasis, and acute neuropsychiatric syndrome with severe hypercalcemia. Currently, PHPT presents few unspecific symptoms. This cross-sectional study was conducted from December 1, 2007, through August 31, 2008 to estimate the prevalence of primary hyperparathyroidism and to describe the clinical and laboratory characteristics of patients receiving ambulatory care.

Low Bone Mass is Associated with Increased Carotid Intima Media Thickness in Men with Type 2 Diabetes Mellitus.

Osteoporosis and atherosclerosis share common risk factors and the association of low bone mass with increased cardiovascular morbidity and mortality has been demonstrated in some studies. Nevertheless, most studies have been focused on women and only a few on individuals with type 2 diabetes mellitus (T2DM). The measurement of carotid intimal-medial thickness (CIMT) is able to detect early atherosclerotic changes and is a predictive marker of cardiovascular events.

Metabolic syndrome and central fat distribution are related to lower serum osteocalcin concentrations.

Background: The aim of this study was to evaluate the association of serum osteocalcin with the metabolic syndrome (MS) in men and premenopausal women.

Methods: 14 middle-aged men and 44 premenopausal women were evaluated. MS was defined according to the International Diabetes Federation criteria.

Vascular effects of bisphosphonates-a systematic review.

Background: Osteoporosis and cardiovascular disease are interconnected entities with pathophysiological similarities. Bisphosphonates are therapeutic options available for resorptive bone diseases; however, experimental evidence has demonstrated a role for bisphosphonates in the inhibition of atherogenesis.

Methods: A systematic review of the vascular effects of bisphosphonates on atherosclerosis was performed.

Normocalcemic versus Hypercalcemic Primary Hyperparathyroidism: More Stone than Bone?

Introduction. Normocalcemic primary hyperparathyroidism (NPHPT) is considered a variant of the more frequent form of the disease characterized by normal serum calcium levels with high PTH. The higher prevalence of renal stones in patients with HPTP and the well established association with bone disorders show the importance of studies on how to manage asymptomatic patients.

Epidemiology of Paget's disease of bone in the city of Recife, Brazil.

Epidemiological studies of Paget's disease of bone (PDB) have shown a remarkable geographical variation in the prevalence rates of the disease. In South America, the frequency is considered to be low, despite scant epidemiological data on this continent regarding the disease. The aim of this study was to evaluate the prevalence and incidence of PDB in one institution in the city of Recife, Northeast Brazil.

Atypical femoral fractures during prolonged use of bisphosphonates: short-term responses to strontium ranelate and teriparatide.

Context: Atypical femoral fractures have rarely been reported in women taking bisphosphonates, but this is still a controversial issue. Data are derived mainly from observation studies because a post hoc analysis from a randomized clinical trial did not find any such association.

Objective: The aim of this study was to report three cases of what are considered atypical femoral fractures and their responses to the use of strontium ranelate and teriparatide.

Prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus and their relationship with duration of the disease and chronic complications.

Unlabelled: Controversial data suggest that patients with type 2 diabetes mellitus have an increased risk of fractures despite having, in some studies, higher bone mineral density.

Methods: The aim of this study was to determine the prevalence of osteoporosis and morphometric vertebral fractures in 148 postmenopausal diabetic women, aged 61.87±7.

Differences in accuracy of 99mTc-sestamibi scanning between severe and mild forms of primary hyperparathyroidism.

Unlabelled: Preoperative localization of the parathyroids using (99m)Tc-sestamibi scanning has not yet been established as a routine diagnostic procedure for primary hyperparathyroidism. Several studies have demonstrated a variable degree of accuracy (70%-98%) in asymptomatic patients.

Methods: We evaluated the accuracy of this technique in 64 patients who underwent scanning between January 2000 and January 2005 according to the clinical manifestations of the disease.

Technical aspects in surgery for endomyocardial fibrosis: experience with 37 patients.

The surgical technique of endocardiectomy and valve replacement for patients with uni- or biventricular endomyocardial fibrosis is described. Technical details of the operation are outlined, based upon experience with 37 surgical cases.