Perioperative Bone Mineral Density Assessment in Patients With Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) increases the risk of osteoporosis and fractures. Despite American Association of Endocrine Surgeons guidelines that recommend bone mineral density (BMD) assessment via dual-energy x-ray absorptiometry (DEXA) for PHPT patients, adherence to these guidelines remains suboptimal.

We performed a retrospective review of preoperative and postoperative DEXA scan practices among PHPT patients at a single academic medical center between 2000 and 2018. Patient data, including demographics and history of bone pathology, was analyzed to identify factors influencing adherence to BMD assessment guidelines.

Of the 3384 PHPT patients evaluated for surgery, only 45.4% (n = 1535) underwent preoperative DEXA scan. Women were significantly more likely to undergo preoperative DEXA than men (49.9% versus 29.0%, P < 0.001). Female sex, age ≥65 y, and a history of bone pain or fractures were significant positive predictors of preoperative DEXA scan. Of patients with 2-y follow-up who did not receive a preoperative DEXA (n = 145), only 13.8% (n = 20) received a postoperative DEXA.

This study highlights gaps in the adherence to national guidelines for DEXA screening among PHPT patients. This underscreening may contribute to increased morbidity due to unidentified osteoporosis. Efforts must be made to improve clinical practice and bring it into line with best practice as recommended by national guidelines.