Surgery Versus Bisphosphonates for Osteoporosis in Primary Hyperparathyroidism: Evaluating Treatment Outcomes

IntroductionOsteoporosis is the most common cause of bone fracture among elderly patients in the United States. Although most instances of osteoporosis are due to demographic risk factors, some patients develop osteoporosis secondary to primary hyperparathyroidism (PHPT). The definitive treatment for these osteoporotic PHPT patients is parathyroidectomy. However, many providers initiate medical treatment with bisphosphonates prior to endocrine surgical referral. This study compares combined medical and surgical therapy against surgical therapy alone for PHPT patients with concomitant osteoporosis.MethodsAn institutional database of patients who underwent surgery for PHPT from October 2016 through July 2023 was reviewed. Anyone with a diagnosis of osteoporosis, osteopenia, or with a DEXA diagnostic of the above were included. Patients were separated into 2 groups based on the administration of bisphosphonates prior to their operation. Outcomes including 6-month cure rates, complication rates, and postoperative bone density scores were compared across groups.ResultsAmong 1055 patients undergoing parathyroidectomy, 138 (13.1%) had osteopenia or osteoporosis. Eighty-one patients (58.7%) received bisphosphonates prior to surgery. There were no significant differences between groups in baseline characteristics or in clinical outcomes, including fracture history, 6-month biochemical cure among patients with available follow-up (n = 53), recurrence, or postoperative hypocalcemia (all P > 0.05). Bone density improvement or stabilization following parathyroidectomy did not differ between groups.ConclusionsIn patients with PHPT and osteoporosis who proceed to timely parathyroidectomy, preoperative bisphosphonate therapy does not appear to provide additional benefit. These findings support direct referral for surgical evaluation without routine initiation of bisphosphonates before definitive surgical treatment.