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Hormonal Influences on Bone Remodeling and Bone Loss: Application to the Management of Primary Hyperparathyroidism

A. Michael Parfitt, MD
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University of Arkansas for Medical Sciences, Little Rock, AR 72205 Requests for Reprints: A. Michael Parfitt, MD, Endocrinology and Metabolism, University of Arkansas for the Medical Sciences Hospital, 4301 West Markham Street, Slot 587, Little Rock, AR 72205.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(5):413-415. doi:10.7326/0003-4819-125-5-199609010-00009
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The apparent prevalence and incidence of primary hyperparathyroidism increased about four-fold after routine multichannel biochemical screening began to be widely used [1]. This increase was sustained, and the average patient age at diagnosis also increased. This indicates that screening did not lead to diagnoses of hyperparathyroidism in the same patients at an earlier age (as occurred with screening for cervical cancer) but rather to the discovery of the condition in many persons who otherwise would have remained unburdened by knowledge of their condition [2]. Such persons—it begs several questions to call them patients, a role they did not seek—have, almost by definition, a condition that is mild, does not progress, and lacks traditional manifestations [23]. The problem of what to do with these persons, a problem now almost 30 years old, is still unsolved.

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