Bone mineral density surveillance before and after parathyroidectomy: A provincial quality assurance retrospective...

Most patients with primary hyperparathyroidism have relatively mild disease with a negative impact on bone mineral density developing over years. Surgery to correct hyperparathyroidism has a protective effect on bone mineral density. The aim of this study was to evaluate the postoperative surveillance and outcomes of osteoporosis patients after parathyroidectomy.

Primary hyperparathyroidism patients who had undergone parathyroidectomy from 2020 to 2022 were identified using a prospective provincial operative reporting database. Follow-up data were extracted from a centralized patient record system. The primary outcome was the rate of bone mineral density evaluation within 5 years postparathyroidectomy in patients with preoperative osteoporosis (T score ≤-2.5). Secondary outcomes were change in bone mineral density and rates of persistent osteoporosis.

There were 305 parathyroidectomy patients with a median age of 64, and 77% were female. Preoperative bone mineral density was available for 245 of 305 (80%) patients, of whom 103 (34%) had osteoporosis. Median follow-up was 2.24 years (interquartile range, 1.04-2.93) for patients with osteoporosis. Only 64% of osteoporosis patients had a repeat bone mineral density within 5 years after surgery. There was a large positive effect on spine and hip bone mineral density and a small positive effect on the radius. In patients with postoperative bone mineral density, 86% still had osteoporosis.

Findings support improved bone mineral density after parathyroid surgery in patients with osteoporosis. However, over one-third of patients did not undergo postoperative bone mineral density reassessment despite having preoperative osteoporosis. Given the high rate of persistent osteoporosis, further investigation is required to identify barriers to postoperative bone mineral density monitoring and to optimize long-term care for this patient population.