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Primary hyperparathyroidism and fracture probability.

John A Kanis1,2, Nicholas C Harvey3,4, Enwu Liu5

  • 1Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.pontefract@shef.ac.uk.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|December 16, 2022
PubMed
Summary
This summary is machine-generated.

Primary hyperparathyroidism (PHPT) increases hip and major osteoporotic fracture risk, even in mild cases. Increased mortality risk in PHPT patients can mask fracture probability, suggesting wider parathyroidectomy indications.

Keywords:
Fracture probabilityHip fractureMortalityPrimary hyperparathyroidism

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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Geriatric Medicine

Background:

  • Primary hyperparathyroidism (PHPT) is linked to elevated fracture risk, potentially influenced by bone mineral density (BMD).
  • Increased mortality in PHPT complicates the assessment of fracture probability.
  • The independent effect of PHPT on fracture risk beyond BMD requires investigation.

Purpose of the Study:

  • To evaluate if PHPT increases hip and major osteoporotic fracture risk independently of BMD.
  • To determine if increased mortality in PHPT affects fracture probability assessment.
  • To analyze the impact of disease severity on fracture risk and mortality.

Main Methods:

  • A Danish register-based study compared 6884 PHPT patients with 68,665 controls.
  • Incidence of death, hip fracture, and major osteoporotic fracture was tracked, excluding post-parathyroidectomy time.
  • Fracture risk gradients relative to BMD were analyzed, with disease severity based on calcium and PTH levels.

Main Results:

  • PHPT patients exhibited higher risks of death (+52%), hip fracture (+48%), and major osteoporotic fracture (+36%) compared to controls.
  • Average 10-year fracture probabilities were elevated in PHPT patients across all ages.
  • Fracture risk did not significantly correlate with BMD differences between PHPT patients and controls; increased mortality attenuated fracture probability assessment.

Conclusions:

  • PHPT elevates hip and major osteoporotic fracture risk irrespective of disease severity.
  • Increased mortality in PHPT patients masks true fracture probability.
  • Conservative management of mild PHPT may underestimate fracture risk, advocating for broader parathyroidectomy indications.