Abstract: 【Abstract】Objective To analyze the short-term variation of bone metabolic markers after parathyroidectomy (PTX) and forearm transplantation; to comprehend the pathogenesis and to improve the diagnosis and treatment of metabolic bone disease in uremic patients with secondary hyperparathyroidism (SHPT). Methods A total of 50 patients treated with PTX for intractable SHPT in the First Affiliated Hospital of Nanjing Medical University from July 2015 to January 2016 were enrolled in this study. Their baseline clinical data, bone metabolism markers including serum intact parathyroid hormone (PTH), calcitonin (CT), alkaline phosphatase (ALP), osteocalcin (OC), type I collagen N-terminal peptide (NTX) and type I collagen C-terminal peptide (CTX) before and after PTX for 3 days were retrospectively analyzed. The correlation between bone metabolic markers and changes of bone metabolic markers after PTX were also analyzed. Results Preoperative bone metabolic markers including serum phosphorus (2.10±0.41 mmol/L), iPTH (1861.55±920.21 ng/L), ALP [283.55 (155.53, 721.78) U/L], OC [290.8 (220, 300) ng/ml], CT (89.66±50.83 pg/mL), NTX [6.0 (4.69, 6.00) μg/L], and CTX [1191.5 (860.4, 1200.0) μg/L] were all increased in the patients. Correlation study of the preoperative bone metabolic markers showed that iPTH and ALP (r=0.782, P＜0.001), iPTH and NTX (r=0.758, P＜0.001), ALP and OC (r=0.637, P＜0.001), NTX and CTX (r=0.749, P＜0.001), and OC and NTX (r=0.311,  P =0.03) were positively correlated. After PTX for 3 days, serum iPTH, CT and CTX decreased to 11.30(5.42, 23.40) ng/L, 63.17±44.20pg/mL, and 1.68 (1.28, 2.33) μg/L respectively (P＜0.05, compared to the values before PTX); OC increased to 300 (300, 300) ng/mL (P＜0.01, compared to the value before PTX). Conclusions In uremic patients with severe SHPT, both osteoblasts and osteoclasts were activated, resulting in the hyperactivity of bone formation and resorption. Bone turnover was then increased. In the short-term period after PTX, osteoblast activity increased further and osteoclast activity decreased.

Key words: Parathyroidectomy, Uremia, Secondary hyperparathyroidism, Bone metabolic markers