Observational studies suggested a link between bone disease and left ventricular (LV) dysfunction
that may be pronounced in hyperparathyroid conditions. We therefore aimed to test
the hypothesis that circulating markers of bone turnover correlate with LV function in a
cohort of patients with primary hyperparathyroidism (pHPT). Cross-sectional data of 155
subjects with pHPT were analyzed who participated in the aEplerenone in Primary Hyperparathyroidism
o (EPATH) Trial. Multivariate linear regression analyses with LV ejection fraction
(LVEF, systolic function) or peak early transmitral filling velocity (e', diastolic function)
as dependent variables and N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin
(OC), bone-specific alkaline phosphatase (BALP), or beta-crosslaps (CTX) as the
respective independent variable were performed. Analyses were additionally adjusted for
plasma parathyroid hormone, plasma calcium, age, sex, HbA1c, body mass index, mean
24-hours systolic blood pressure, smoking status, estimated glomerular filtration rate, antihypertensive
treatment, osteoporosis treatment, 25-hydroxy vitamin D and N-terminal probrain
B-type natriuretic peptide. Independent relationships were observed between P1NP
and LVEF (adjusted β-coefficient = 0.201, P = 0.035) and e' (β = 0.188, P = 0.042), respectively.
OC (β = 0.192, P = 0.039) and BALP (β = 0.198, P = 0.030) were each independently
related with e'. CTX showed no correlations with LVEF or e'. In conclusion, high bone formation
markers were independently and paradoxically related with better LV diastolic and,
partly, better systolic function, in the setting of pHPT. Potentially cardio-protective properties of stimulated bone formation in the context of hyperparathyroidism should be explored in
future studies.
