Factors influencing bone mineral density in hyperparathyroidism phenotypes: a prospective study

Area of Science:

• Endocrinology
• Bone Metabolism
• Surgical Outcomes

Background:

• Primary hyperparathyroidism (PHPT) presents with distinct biochemical phenotypes: hypercalcemic, normocalcemic, and normohormonal.
• PHPT leads to high bone turnover and decreased bone mineral density (BMD).
• Parathyroidectomy (PTX) improves BMD, but phenotype-specific data is limited.

Purpose of the Study:

• To identify optimal surgical candidates among PHPT phenotypes.
• To examine symptoms, comorbidities, and biochemical results related to BMD changes post-PTX.
• To compare pre- and post-operative BMD changes across PHPT phenotypes.

Main Methods:

• Prospective single-center study of 104 patients undergoing PTX for PHPT.
• Collection of sociodemographic and biochemical data pre- and 6 months post-surgery.
• Dual-energy x-ray absorptiometry (DXA) scans assessed BMD at 1, 6 months pre- and 12-18 months post-surgery.

Main Results:

• Significant BMD gain observed in 40% (spine), 35.1% (femur), and 23.5% (left hip).
• Greater postoperative PTH drop correlated with increased BMD at spine and femur.
• No significant BMD change at the radius; higher preoperative urinary calcium linked to left hip improvement.

Conclusions:

• Curative PTX improves BMD in all PHPT patients, regardless of phenotype, age, or sex.
• Patients with more severe biochemical profiles showed greater BMD and T-score increases.
• Milder PHPT forms show favorable trends requiring further investigation in larger cohorts.