Impact of obesity on bone metabolism.

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Abstract

[Indexed for MEDLINE] 7. Endocr Rev. 2025 Jul 15;46(4):576-620. doi: 10.1210/endrev/bnaf010. Bone in Parathyroid Diseases Revisited: Evidence From Epidemiological, Surgical and New Drug Outcomes. Roumpou A(1), Palermo A(2)(3), Tournis S(4), Hasenmajer V(5)(6), Pasieka JL(7), Kaltsas G(8)(9), Isidori A(5)(6), Kassi E(8)(9)(10). Author information: (1)Endocrine and Bone Metabolic Disorders Unit, Second Propaedeutic Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece. (2)Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome 00128, Italy. (3)Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome 00128, Italy. (4)Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", Medical School, National and Kapodistrian University of Athens, KAT General Hospital, Kifissia 14561, Athens, Greece. (5)Department of Experimental Medicine Sapienza, Endocrine and Andrological Regional, University of Rome, Rome 00185, Italy. (6)Rare Disease Center (Endo-ERN accredited), Policlinico Umberto I, Rome 00161, Italy, European Reference Network on Rare Endocrine Conditions (ENDO-ERN). (7)Departments of Surgery and Oncology, University of Calgary, Calgary, Canada AB T2N 2T9. (8)Division of Diabetes, Endocrinology and Metabolic Diseases, First Department of Propaedeutic and Internal Medicine, General Hospital of Athens LAIKO, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece. (9)Center of Expertise for Rare Endocrine Diseases (ENDO-ERN accredited), General Hospital of Athens LAIKO, National and Kapodistrian University of Athens, Athens 11527, Greece, European Reference Network on Rare Endocrine Conditions (ENDO-ERN). (10)Department of Biogolical Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece. PTH-related disorders have a major impact on bone metabolism and skeletal properties because of the pivotal role of PTH in calcium and phosphate homeostasis and bone remodeling. Hyperparathyroidism is characterized by continuous exposure to excessive endogenous PTH, causing increased bone turnover in favor of bone resorption. Depending on the background of PTH overproduction, hyperparathyroidism is divided into primary, secondary, and tertiary hyperparathyroidism. The clinical presentation varies from deterioration of bone microarchitecture and decreased bone mineral density to profound bone involvement, such as osteitis fibrosa cystica and fragility fractures. Although successful parathyroidectomy represents the definitive treatment and may promote regression of most of the skeletal defects, the medical approach of calcimimetics and antiresorptive agents is a promising alternative in cases where parathyroidectomy is not feasible or unsuccessful. Hypoparathyroidism is the pathophysiological counterpart of hyperparathyroidism and also leads to disorders of bone metabolism and structure. Chronic PTH deprivation is associated with low bone remodeling and increased bone mineral density. The defective microarchitecture might affect bone strength and raise the risk for adverse skeletal events. Recombinant human PTH acts as a replacement therapy and is safe and efficient in restoring calcium/phosphate homeostasis and bone turnover. However, it is approved only for refractory cases, as conventional management with calcium and active vitamin D remains the first-line treatment. This article reviews the skeletal involvement in the most frequent parathyroid disorders, hyperparathyroidism and hypoparathyroidism, and rare familial disorders of PTH metabolism, as assessed by clinical, laboratory, and imaging parameters, and the effect of the available treatment strategies. © The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society. DOI: 10.1210/endrev/bnaf010 PMCID: PMC12259238