Osteoporosis and Normocalcemic Primary Hyperparathyroidism (Conservatively or Surgically Managed)

Area of Science:

• Endocrinology
• Metabolic Bone Disease

Background:

• Normocalcemic primary hyperparathyroidism (NPHPT) is a variant of primary hyperparathyroidism (PHPT) with a variable prevalence.
• Asymptomatic PHPT constitutes the majority of PHPT cases in contemporary medical practice.

Purpose of the Study:

• To analyze bone status and mineral metabolism in NPHPT patients under conservative or surgical management.
• To compare NPHPT with hypercalcemic PHPT (HPHPT) regarding bone health outcomes.

Main Methods:

• A narrative review of PubMed-searched studies from January 2020 to July 2024.
• Analysis included 14 studies encompassing 388 NPHPT patients, 1188 PHPT patients, and 803 controls.

Main Results:

• Osteoporosis was prevalent in 41.7-100% of NPHPT subjects.
• Fracture prevalence in NPHPT varied from 7.4% to 42.8%.
• Bone turnover markers were lower in NPHPT compared to PHPT, with potential improvements post-parathyroidectomy.

Conclusions:

• Early diagnosis and management of PHPT, including NPHPT, are crucial due to potential complications.
• Increased screening in patients with osteoporosis or kidney stones may identify NPHPT.
• Further prospective studies are needed to clarify NPHPT's natural course and optimize management strategies, including parathyroidectomy indications.