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 “Eplerenone in Primary
Hyperparathyroidism” (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 pro-brain 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
