From the Guidelines
Osteitis fibrosa cystica is typically associated with primary or secondary hyperparathyroidism rather than tertiary hyperparathyroidism.
Key Points
- Secondary hyperparathyroidism is the most common form of hyperparathyroidism associated with osteitis fibrosa cystica, particularly in patients with chronic kidney disease (CKD) 1.
- Primary hyperparathyroidism can also cause osteitis fibrosa cystica, as seen in the general population 1.
- Tertiary hyperparathyroidism is a rare condition that can occur in patients with long-standing secondary hyperparathyroidism, typically after kidney transplantation, and is characterized by hypercalcemic hyperparathyroidism 1.
Evidence Summary
Studies have shown that osteitis fibrosa cystica is a common bone lesion in patients with CKD, particularly those with secondary hyperparathyroidism 1. The use of active vitamin D sterols, such as calcitriol, can reduce serum levels of intact PTH, improve bone histology, and increase bone mineral density (BMD) in these patients 1. In contrast, tertiary hyperparathyroidism is a distinct entity that requires surgical excision in medically refractory cases 1.
Clinical Implications
In clinical practice, osteitis fibrosa cystica is more likely to be associated with primary or secondary hyperparathyroidism, and treatment should focus on controlling serum phosphorus levels, using calcium-based phosphate binders, and administering active vitamin D sterols as needed 1.
From the Research
Osteitis Fibrosa Cystica and Hyperparathyroidism
- Osteitis fibrosa cystica is a rare complication of secondary hyperparathyroidism, as seen in a case report of a 26-year-old woman with end-stage renal disease 2.
- It is also a rare presentation of both primary and secondary hyperparathyroidism, with a historical backdrop and still seen today, particularly in primary hyperparathyroidism 3.
- The condition is related to long-standing, end-stage hyperparathyroidism, and can mimic primary bone tumors clinically, leading to misdiagnosis and inappropriate management 4.
Primary vs. Secondary Hyperparathyroidism
- Osteitis fibrosa cystica is a classical manifestation of primary hyperparathyroidism, which can be the first sign of the disease, but is rarely recognized due to its rarity in the United States and Western Europe 5.
- Primary hyperparathyroidism with osteitis fibrosa cystica can present with pathological fractures that masquerade as malignancy, and the diagnosis is often not considered due to its rarity 5.
- A case report of a 37-year-old woman with primary hyperparathyroidism and osteitis fibrosa cystica highlights the importance of considering this condition in the differential diagnosis of skeletal disease, particularly in young patients with low-energy fractures 6.
Tertiary Hyperparathyroidism
- There is no evidence in the provided studies to suggest that osteitis fibrosa cystica is typically associated with tertiary hyperparathyroidism.
- The studies primarily discuss the association of osteitis fibrosa cystica with primary and secondary hyperparathyroidism, with no mention of tertiary hyperparathyroidism as a common cause of the condition 2, 3, 4, 5, 6.