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ABSTRACT Primary hyperparathyroidism (PHPT) is an endocrine disorder resulting from the hyperfunction of one or more parathyroid glands, with hypersecretion of parathyroid hormone (PTH). It can be managed by parathyroidectomy (PTX) or non-surgically. Medical therapy with pharmacological agents is an alternative for those patients with asymptomatic PHPT who meet guidelines for surgery but are unable or unwilling to undergo PTX. In this review, we focus upon these non-surgical aspects of PHPT management. We emphasize the most studied and widely used pharmacological alternatives: bisphosphonates, denosumab, cinacalcet and hormone therapy, in addition to combined therapy. We also address the relevant aspects of perioperative management.

ABSTRACT Denosumab (DMAb) is a human monoclonal antibody used as an antiresorptive drug in the treatment of osteoporosis. Approval at a dosage of 60 mg every 6 months was based on the results of the randomized, placebo-controlled trial (FREEDOM). The design of this 3-year study included an extension for up to 10 years. Those who were randomized to DMAb continued on drug, while those who were randomized to placebo transitioned to DMAb. The 10-year experience with DMAb provides data on efficacy of drug in terms of reduced fractures and continued increases in bone mineral density (BMD). The 10-year experience with denosumab also provides information about rare complications associated with the use of DMAb, such as osteonecrosis of the jaw (ONJ), and atypical femoral fractures (AFF). This experience provided new insights into the reversibility of effects upon discontinuation without follow-on therapy with another agent. This review focuses upon prolonged treatment with DMAb, with regard to beneficial effects on fracture reduction and safety. Additionally, its use in patients with impaired renal function, compare its results with those of bisphosphonates (BPs), the occurrence/frequency of complications, in addition to the use of different tools, from imaging techniques to histological findings, to evaluate its effects on bone tissue.

Background. Parathyroid carcinoma accounts for

Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin–angiotensin–aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.

A vitamina D é lipossolúvel e tem suas ações influenciadas por numerosos moduladores, sendo indispensável para saúde esquelética, neurológica, imunológica e cardiovascular, havendo cada vez mais apontamentos de que a hipovitaminose D aumenta o risco de morbimortalidade hospitalar. Este trabalho objetivou realizar uma revisão da literatura recente, com estudos publicados entre 2009 e 2018 em importantes bancos de dados de saúde, sobre a deficiência da vitamina D em pacientes críticos e as suas possíveis consequências. Utilizou-se os descritores “cuidados críticos” and “vitamina D”. Foram selecionados 8 trabalhos. Constatou-se maiores índices da deficiência nutricional nos pacientes em terapia intensiva do que em pacientes hígidos, em diferentes faixas etárias, havendo sugestão de que a hipovitaminose estaria associada a maiores taxas de mortalidade. A suplementação da vitamina D nessas condições ainda não foi amplamente estudada, mas observa-se uma tendência a ser benéfica, não trazendo eventos adversos. Conclui-se que a hipovitaminose D provavelmente está associada a piores desfechos clínicos em pacientes graves, mostrando a necessidade de grandes estudos multicêntricos randomizados para comprovação da necessidade da sua investigação e da sua correção.