Use and Implications of the Fracture Risk Assessment Tool in Primary Hyperparathyroidism

Area of Science:

• Endocrinology
• Orthopedics
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) is linked to increased osteoporotic fracture risk.
• Accurate fracture risk estimation in PHPT patients is challenging.
• The utility of the Fracture Risk Assessment Tool (FRAX) in PHPT and its role in guiding parathyroidectomy (PTX) decisions are not well understood.

Purpose of the Study:

• To evaluate the calibration of FRAX in adults diagnosed with PHPT.
• To assess the association between FRAX-estimated fracture probability and the outcomes of PTX versus nonsurgical management.

Main Methods:

• A retrospective cohort study utilizing the TriNetX electronic health record US dataset from 2000 to 2024.
• Included adults aged 40-90 years with PHPT, excluding those with incomplete FRAX data.
• Compared fracture outcomes (major osteoporotic fracture and hip fracture) between patients undergoing PTX and those managed nonsurgically, calculating 10-year FRAX probabilities without bone mineral density (BMD).

Main Results:

• FRAX demonstrated acceptable calibration for both major osteoporotic fractures (MOF) and hip fractures in the PHPT cohort.
• PTX was associated with a reduced risk of MOF (12% decrease) and hip fracture (13% decrease) compared to nonsurgical management.
• A significant proportion of patients not meeting traditional surgical criteria could benefit from PTX for fracture risk reduction based on specific FRAX score thresholds.

Conclusions:

• FRAX is a useful tool for stratifying fracture risk in PHPT patients, even without BMD data.
• The findings suggest that PTX may offer fracture prevention benefits to a broader patient population than currently recommended by guidelines.
• FRAX can aid in surgical decision-making for PHPT patients aiming to reduce fracture risk.