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Joseph M. Lane, MD
Associate Director of Orthopedic Trauma Service
New York-Presbyterian Hospital
New York, New York

Thomas A. Einhorn, MD
Professor and Chairman
Department of Orthopedic Surgery Boston University School of Medicine
Chief, Orthopedic Surgery
Boston University Medical Center
Boston, Massachusetts

Frederick Kaplan, MD
Professor of Orthopedic Molecular Medicine
University of Pennsylvania
Philadelphia, Pennsylvania

Pretest

Introduction

Hyperparathyroidism is a condition which is caused by excessive amounts of parathyroid hormone (PTH). The primary etiologies of hyperparathyroidism are, in decreasing order, adenoma, hyperplasia and cancer. Secondary etiologies include osteomalacia/rickets and renal osteodystrophy.

Clinical symptoms of hyperparathyroidism include: bone pain, brown tumors, pathologic fractures, renal stones and ulcers. Radiographic evidence include: brown tumors; salt and pepper skull; osteopenia/osteosclerosis; soft tissue calcification; scalloping or loss of phalangeal tissue; clavicular phalangeal tuft; distal erosion; soft tissue calcification and decreased bone density.

Laboratory findings in primary hyperparathyroidism show an increase in calcium, decrease in phosphate and an increase in PTH. Laboratory evidence in secondary hyperthyroidism indicates a decrease in calcium, an increase in renal phosphate and an increase in PTH. For ectopic, or malignant hyperparathyroidism the laboratory evidence is increased calcium, decreased phosphate and decreased PTH.

Bibliography

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, et al. Risk factors for hip fracture in white women. study of osteoporotic fracture research group. N Engl J Med. 1995;332:767-773.
Drinkwater BL, Grimston SK, Roab-Cullen DM, Snow-Harten CM. ACSM position stand on osteoporosis and exercise. Med Sci Sports Exercise. 1995;27:745-750.
Favus MJ. Primer on the metabolic bone disease and disorders of mineral metabolism, 2nd edition. Philadelphia, Pa:Lippincott-Raven; 1993.
Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994;271:128-133.
Lane JM, Riley EH, Wirganowicz PZ. Osteoporosis: diagnosis and treatment. J Bone Joint Surg. 1996;78-A(4):618-632.
Lane JM, Riley EH. New advances in osteoporosis: editorial review. Current Opinion in Orthopedics. 1994;5:108.
Lane JM, Scaduto A. Recent advances in drug therapy for osteoporosis current opinion in orthopaedics. Current Opinion in Orthopaedics. 1995;6:6.
Pak CYC, Sakhall K, Adams-Huet B, Piziak V, Peterson RD, Poindexter JR. Treatment of post menopausal osteoporosis with slow release sodium fluoride: final report of a randomized controlled trial. Annals Int Med.. 1995;123: 401-408.
Riggs BL, Melton LJ. The prevention and treatment of osteoporosis. N Engl J Med. 1992;327: 620-627.