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OBJECTIVE: To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica. METHODS: Review of the medical records of six patients using bisphosphonates preoperatively. RESULTS: Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm(2) (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm(2) (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm(2) (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62%. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40% ± 29% in L2-L4, 86 ± 39% in the femoral neck, and 22% ± 11% in radius 33. CONCLUSION: The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.

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OBJETIVO: Avaliar o efeito dos bisfosfonatos na hipocalcemia pós-paratireoidectomia em pacientes com osteíte fibrosa cística. MÉTODOS: Foram revisados os prontuários de seis pacientes que fizeram uso pré-operatório de bisfosfonatos. RESULTADOS: A idade média foi de 35,6 ± 10,5 anos; cálcio sérico 13,51 ± 0,87 mg/dL; PTHi 1.389 ± 609 pg/mL. O valor médio de deoxipiridinolina urinária (UDPD) de três pacientes foi de 131 ± 183 nmol/mmol Cr; e do C-telopeptídeo (CTX) de 2.253 ± 1.587 pg/mL. Densitometria óssea (escore T) obteve média de 0,673 ± 0,150 g/cm² (-4,42 ± 1,23) em coluna lombar (CL); 0,456 ± 0,149 g/cm² (-5,58 ± 1,79) em colo de fêmur (CF) e 0,316 ± 0,055 g/cm² (-5,85 ± 0,53) em rádio 33 (RD). Um paciente recebeu alendronato oral 30 mg/dia por 4 semanas; o cálcio diminuiu de 14 para 11,6 mg/dL e UDPD de 342 para 160 nmol/mmol Cr. Outro usou alendronato oral 20 mg/dia por 6 semanas; o cálcio baixou de 14 para 11,0 mg/dL e UDPD de 28,8 para 14 nmol/mmol Cr. Um paciente recebeu pamidronato 90 mg endovenoso antes da cirurgia. Um paciente usou alendronato oral 140 mg/semana por 6 semanas; o cálcio diminuiu de 13,7 para 12,3 mg/dL e o CTX de 2.160 para 1.340 pg/mL. Outro usou alendronato VO 140 mg/semana por 6 semanas; o cálcio baixou de 14,3 para 14,1 mg/dL; o CTX não reduziu. Um paciente fez ibandronato 150 mg 10 dias antes da cirurgia; o CTX caiu em 62 por cento. Nenhum paciente desenvolveu hipocalcemia grave na primeira semana do pós-operatório. Um ano após a cirurgia, houve aumento de 40 ± 29 por cento em CL, 86 ± 39 por cento em CF e 22 ± 11 por cento em RD. CONCLUSÃO: O uso pré-operatório de bisfosfonatos parece atenuar a fome óssea sem impedir o marcante aumento de massa óssea no seguimento da paratireoidectomia.

OBJECTIVE: To assess the effect of bisphosphonates on post-parathyroidectomy hypocalcemia in patients with osteitis fibrosa cystica. METHODS: Review of the medical records of six patients using bisphosphonates preoperatively. RESULTS: Mean age was 35.6 ± 10.5 years; serum calcium = 13.51 + 0.87 mg/dL; iPTH = 1,389 + 609 pg/mL. The mean value of urine deoxypyridinoline (UDPD) of three patients was 131 ± 183 nmol/mmol Cr, and of C-telopeptide (CTX), 2,253 ± 1,587 pg/mL. The mean values of bone densitometry (T score) were as follows: 0.673 ± 0.150 g/cm² (-4.42 ± 1.23) in lumbar spine (L2-L4); 0.456 ± 0.149 g/cm² (-5.58 ± 1.79) in the femoral neck; and 0.316 ± 0.055 g/cm² (-5.85 ± 0.53) in radius 33. Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. Patient 2 received oral alendronate, 20 mg/day for six weeks; his calcium decreased from 14 to 11.0 mg/dL and his UDPD from 28.8 to 14 nmol/mmol Cr. Patient 3 received intravenous pamidronate, 90 mg prior to surgery. Patient 4 received oral alendronate, 140 mg/week for six weeks; her calcium decreased from 13.7 to 12.3 mg/dL and her CTX from 2,160 to 1,340 pg/mL. Patient 5 received oral alendronate, 140 mg/ week for six weeks; her calcium levels dropped from 14.3 to 14.1 mg/dL; her CTX did not change. Patient 6 received ibandronate, 150 mg, ten days prior to surgery; his CTX reduced by 62 percent. No patient developed severe hypocalcemia in the first postoperative week. One year after surgery, the mean gain in bone mineral density was 40 percent ± 29 percent in L2-L4, 86 ± 39 percent in the femoral neck, and 22 percent ± 11 percent in radius 33. CONCLUSION: The preoperative use of bisphosphonates seems to attenuate bone hunger without preventing a significant increase in bone mass in the follow-up of parathyroidectomy.

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Hashimoto's encephalopathy, first described in 1966, is still problematic in terms of its pathophysiology, diagnosis, and treatment. The syndrome is more common in women, and is associated with autoimmune antithyroid antibodies. Presentation varies considerably; there may be episodes of cerebral ischemia, seizure, or psychosis, or there may be depression, cognitive decline, and periods of fluctuating consciousness. Because the symptoms respond so well to immunosuppressive treatment, prompt diagnosis and management are important. Here, the authors present a representative case report, along with a comprehensive review of current literature.

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OBJECTIVE: To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS: Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS: Mean +/- SD of serum 25OHD levels were 80.6 +/- 43.3 nmol/L (Group 1) and 63.7 +/- 27.6 nmol/L (Group 2); 24% had 25OHD levels < 25 nmol/L and 43.7% < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 +/- 0.102 vs. 0.793 +/- 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 +/- 8.4 vs. 16.2 +/- 8.4 years, p = 0.01). CONCLUSION: We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.

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OBJECTIVE: To evaluate bone metabolism, bone density (BMD) and vertebral fractures in morbidly obese individuals. SUBJECTS AND METHODS: Case series of 29 premenopausal obese patients, 15 of whom had been submitted to bariatric surgery. Serum calcium, albumin, PTH and 25-hydroxy vitamin D (25OHD) were measured as well as bone densitometry of the lumbar spine and proximal femur, and lateral spine x-rays. RESULTS: High parathyroid hormone (PTH) levels were recorded in 46.6% of the surgical patients and in 21.4% of the non-surgical patients (p = 0.245); 26.7% of the former and 28.6% of the latter revealed levels 25OHD < 30 ng/mL (p = 1.000). Calcium intake was higher in the surgical group (p = 0.004) along with lower serum calcium concentrations (p = 0.019). There were no significant differences in bone mineral density (BMD) or in the prevalence of vertebral fractures between groups. CONCLUSION: In premenopausal women undergoing Roux-en-Y gastric bypass there is important intestinal calcium mal absorption which seems to be the main factor causing secondary hyperparathyroidism.

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OBJECTIVE: To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS: Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS: Mean ± SD of serum 25OHD levels were 80.6 ± 43.3 nmol/L (Group 1) and 63.7 ± 27.6 nmol/L (Group 2); 24 percent had 25OHD levels < 25 nmol/L and 43.7 percent < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 ± 0.102 vs. 0.793 ± 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 ± 8.4 vs. 16.2 ± 8.4 years, p = 0.01). CONCLUSION: We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.

OBJETIVO: Determinar o perfil da vitamina D (25OHD) e sua relação com a densidade mineral óssea (DMO) em 93 mulheres na pós-menopausa. SUJEITOS E MÉTODOS: As pacientes foram distribuídas em dois grupos: grupo 1 - 51 a 65 anos (45 pacientes) e 2 - 66 a 84 anos (48 pacientes); foram analisados 25OHD e PTH séricos e realizou-se exame de DXA em coluna lombar (LS) e colo do fêmur (FN). RESULTADOS: As médias ± desvio-padrão (DP) dos níveis de 25OHD foram 80,6 ± 43,3 nmol/L (grupo 1) e 63,7 ± 27,6 nmol/L (grupo 2); 24 por cento tinham 25OHD < 25 nmol/L e 43,7 por cento, < 50 nmol/L. A prevalência de deficiência de 25OHD, considerando 62,5 nmol/L como ponto de corte, aumentou significativamente com a idade. Pacientes com hipovitaminose D tinham uma menor DMO no FN (0,738 ± 0,102 vs. 0,793 ± 0,115 g/cm², p = 0,03) e maior tempo de pós-menopausa (21,0 ± 8,4 vs. 16,2 ± 8,4 anos, p = 0,01). CONCLUSÃO: Encontrou-se alta prevalência de hipovitaminose D em mulheres na pós-menopausa. Idade, anos desde a menopausa e baixa DMO no FN estavam associados à deficiência.

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OBJECTIVE: To evaluate bone metabolism, bone density (BMD) and vertebral fractures in morbidly obese individuals. SUBJECTS AND METHODS: Case series of 29 premenopausal obese patients, 15 of whom had been submitted to bariatric surgery. Serum calcium, albumin, PTH and 25-hydroxy vitamin D (25OHD) were measured as well as bone densitometry of the lumbar spine and proximal femur, and lateral spine x-rays. RESULTS: High parathyroid hormone (PTH) levels were recorded in 46.6 percent of the surgical patients and in 21.4 percent of the non-surgical patients (p = 0.245); 26.7 percent of the former and 28.6 percent of the latter revealed levels 25OHD < 30 ng/mL (p = 1.000). Calcium intake was higher in the surgical group (p = 0.004) along with lower serum calcium concentrations (p = 0.019). There were no significant differences in bone mineral density (BMD) or in the prevalence of vertebral fractures between groups. CONCLUSION: In premenopausal women undergoing Roux-en-Y gastric bypass there is important intestinal calcium mal absorption which seems to be the main factor causing secondary hyperparathyroidism.

OBJETIVO: Avaliar o metabolismo ósseo, a densidade mineral óssea (DMO) e as fraturas vertebrais em obesos mórbidos. SUJEITOS E MÉTODOS: Série de casos de 29 mulheres obesas e na pré-menopausa das quais 15 foram submetidas à cirurgia bariátrica. Realizadas dosagem sérica de cálcio, albumina, hormônio da paratireoide (PTH) e 25-hidróxi-vitamina D (25OHD), densitometria óssea de coluna lombar e fêmur e radiografia de coluna vertebral. RESULTADOS: Os níveis de PTH estavam elevados em 46,6 por cento das pacientes operadas e em 21,4 por cento das pacientes não operadas (p = 0,245); 26,7 por cento das operadas e 28,6 por cento das não operadas apresentavam 25OHD < 30 ng/mL (p = 1,000). A ingestão de cálcio foi maior no grupo operado (p = 0,004) e o cálcio sérico foi menor neste grupo (p = 0,019). Não houve diferenças significativas na densidade mineral óssea (DMO) e na prevalência de fraturas vertebrais entre os grupos. CONCLUSÃO: Em mulheres na pré-menopausa, submetidas ao bypass gástrico em Y de Roux, há considerável má absorção intestinal de cálcio, que parece ser o principal fator causador do hiperparatireoidismo secundário.

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In South America the incidence of Paget's disease of bone (PDB) is low and more than half of the cases published in the last 30 years come from Brazil and Argentina. The aim of this study was to describe the clinical and epidemiological characteristics of PDB in two institutions in Pernambuco. PDB patients in Recife, Brazil were studied retrospectively. A total of 108 cases were diagnosed from 1984 to 2005. Over 90% of the patients were of European descent. The average age was 66.2 years and 49.1% were male. The polyostotic form was the more common. Pain and bone deformity were significantly more frequent in this group and in the total group. Clear eyes were observed in 22.2% of the patients and 23.1% had a family history record of PDB. The most frequently affected bones were the pelvis, lumbar vertebrae, femurs, and skull. Zoledronate was the most effective drug in reducing the alkaline phosphatase. Our data show that PDB in Recife occurs predominantly among those of European descents, usually in the polyostotic presentation, thus providing evidence of genetic and historical factors in the prevalence of PDB in that region.

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