Surgery bests oral med for boosting bone density in dialysis patients

For patients undergoing peritoneal dialysis, parathyroidectomy yields bigger increases in the bone mineral density (BMD) of lumbar spine and femoral neck as well as decreases in osteopenia/osteoporosis, according to a study.

The study included 65 patients who were receiving maintenance peritoneal dialysis (PD) and had advanced secondary hyperparathyroidism. These patients were randomly assigned to undergo total parathyroidectomy with forearm autografting or receive oral cinacalcet treatment for 12 months.

Outcomes included changes in BMD Z- and T-scores of femoral neck, lumbar spine, and distal radius 12 months after treatment initiation. Osteopenia or osteoporosis status, according to the World Health Organization, was also assessed.

At 12 months, both groups showed significant improvements in BMD of the lumbar spine and femoral neck, but the magnitude of improvement was greater in the parathyroidectomy vs cinacalcet group (p<0.001).

The proportion of patients classified as having osteopenia/osteoporosis based on the femoral neck T-score dropped significantly from 78.2 percent to 51.7 percent following parathyroidectomy (p<0.001) and numerically decreased from 65.7 percent to 52.0 percent following cinacalcet treatment (p=0.7).

A similar pattern was observed when the definition was based on T-score at lumbar spine, with the proportion of patients having osteopenia/osteoporosis decreasing from 53.1 percent to 31.0 percent in the parathyroidectomy group (p=0.01) and from 59.4 percent to 53.8 percent in the cinacalcet group (p=0.3).

BMD T- or Z-score of distal radius at 12 months did not significantly change with either intervention.