Effect of parathyroidectomy versus conservative management on bone mineral density in patients with primary...

Hyperparathyroidism stimulates osteoclasts to increase bone resorption, release skeletal calcium, and cause a reduction of bone mass. Parathyroidectomy remains the only curative treatment however medical therapies can also control symptoms and limit osteoporosis. The aim of this study was to compare the impact of parathyroidectomy with medical management on bone mineral density (BMD) in patients with primary hyperparathyroidism.

An observational study including a total of 82 patients with hyperparathyroidism, comprising the Surgical Group (n=49) and Medical Group (n=33). Patients had BMD assessed at the lumbar spine, hip and forearm using dual-energy X-ray absorptiometry before and after intervention.

At a mean follow-up of 4.3 years, BMD increased in the lumbar spine by +6.8% (P=0.004) in the Surgical Group and +3.1% (P=0.016) in the Medical Group. BMD was recovered or maintained in all regions in the Surgical Group, whereas a decrease of -7.1% (P=0.043) was noted in the forearms of the Medical Group. Significant between-group differences in BMD change favouring the Surgical Group in the total hip (+1.6% vs -1.7%, P=0.019), distal one-third radius (+0.3% vs -7.1%, P=0.045) and ultra-distal radius (+2.0% vs -9.1%, P=0.003). A greater proportion of patients in the Medical Group developed osteopenia or osteoporosis (P<0.001).

This study has demonstrated that BMD improved or was preserved more greatly in patients with primary hyperparathyroidism who underwent parathyroidectomy rather than non-surgical management at 4 years follow-up. Greater BMD preservation in both groups, compared to previous studies, may be explained by greater utilisation of available medical therapies.