Assessing and Managing Primary Hyperparathyroidism and Fracture Risk in England: A Survey of Medical Professionals

Area of Science:

• Endocrinology
• Metabolic Bone Disease
• Clinical Practice Research

Background:

• Primary hyperparathyroidism (PHPT) is a significant risk factor for fractures.
• Optimal diagnostic and management strategies for PHPT in patients with fractures are not well-defined.
• Variability in clinical practice can impact patient outcomes.

Purpose of the Study:

• To describe current diagnostic approaches for PHPT in patients with recent fractures.
• To outline management strategies employed by secondary care professionals for PHPT and high fracture risk.
• To identify variations in clinical practice within England.

Main Methods:

• A survey was developed targeting secondary care professionals managing patients at high fracture risk with probable PHPT.
• The survey was distributed to 50 professionals identified by the Society for Endocrinology Calcium and Bone special interest group.
• Data were analyzed using descriptive statistics, combinatorial analysis, and thematic analysis.

Main Results:

• Diagnostic preferences included 24-hour urinary calcium:creatinine clearance ratio (54%) and spot urinary calcium:creatinine clearance ratio (32%).
• Fracture risk assessment (96%) and DXA scans (85%) were consistently included in management plans.
• Vitamin D correction (94%) preceded antiosteoporotic medication (AOM) initiation, with IV zoledronate acid being the preferred AOM. Cinacalcet use was supported by 58% for surgical ineligibility.

Conclusions:

• Clinical practices for managing PHPT in patients with high fracture risk exhibit considerable variation among NHS staff.
• There is a clear need for the development of pragmatic clinical guidelines.
• Wider educational initiatives are required to standardize care and improve management of PHPT and associated fracture risk.