Postparathyroidectomy Bone Density Changes in Patients With Biochemically Mild Primary Hyperparathyroidism

Primary hyperparathyroidism significantly impacts bone health leading to decreased bone mineral density (BMD). We assessed changes in BMD following parathyroidectomy in patients with biochemically mild primary hyperparathyroidism.

A retrospective chart review of 93 patients with primary hyperparathyroidism who underwent parathyroidectomy between 2000 and 2022 was conducted. Dual-energy x-ray absorptiometry (DXA) scans were done at the same site pre- and postparathyroidectomy at varying time points. Statistical analyses were performed using ANOVA as the homogeneity of variance was > 0.05. A P-value of <0.05 was considered statistically significant.

No statistically significant differences in DXA measurements were observed based on age, timing of DXA after parathyroidectomy, number and total weight of removed parathyroid glands, preoperative vitamin D levels, or preoperative 24-hour urinary calcium levels. In site-specific analysis based on T-scores at individual skeletal regions, only the femoral neck showed a significant postoperative BMD improvement in osteoporotic patients compared to those with osteopenia (P = .018) and normal bone density (P = .019), while the lumbar spine and total hip did not. When patients were grouped by overall osteoporosis status-defined as having osteoporosis at any site-significant BMD improvements were observed at the femoral neck and total hip compared to those with osteopenia (P = .031 and P = .015, respectively).

These findings underscore the potential for tailored interventions in managing bone health in patients with mild primary hyperparathyroidism, emphasizing the need for personalized approaches to optimize outcomes.