Jesse C. Krakauer
Krakauer JC. Bone Density and Body Weight in Hyperparathyroidism. Ann Intern Med. 1995;122:801. doi: 10.7326/0003-4819-122-10-199505150-00018
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Published: Ann Intern Med. 1995;122(10):801.
TO THE EDITOR:
Grey and colleagues  used dual-energy x-ray absorptiometry to support a change in our thinking about primary hyperparathyroidism. Unfortunately for clinicians in the United States, the Food and Drug Administration has forced the withdrawal of body-composition output from x-ray absorptiometry instruments pending additional licensing. Grey and colleagues based their conclusions on a complete (except forearm scans) acquisition of x-ray absorptiometry data from a cohort of patients and age-matched controls. They presented the bone mineral density results as unadjusted and weight-adjusted values in g/cm2 on a single scale for the site-specific (lumbar spine, femur) and total body scans (total, arms). Their results show little overall difference in bone mineral density but seem to support the concept that hyperparathyroidism has a differential effect on the skeleton at different sites (spine < femur < arms). Perhaps it would be instructive to view their data by the percentage of matched normal controls that is directly available on the output from standard x-ray absorptiometry scans (even in the United States). It would also be of interest to determine whether their controlled data support a recent personal observation that patients referred for assessment of hyperparathyroidism have a higher matched percentage bone mineral density on the lateral lumbar scan than on the posteroanterior scan, with the opposite result often seen in steroidal  or hypogonadal osteopenia. The data set of Grey and colleagues probably could establish whether the overall pattern of bone mineral density or the difference between lumbar spine projections is useful in diagnosing the effects of hyperparathyroidism on the skeleton.
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