Parathyroidectomy Improves and Bisphosphonates Worsen Fracture Risk in Primary Hyperparathyroidism Save

A retrospective observational study of over 6000 patients with primary hyperparathyroidism (PHPT), followed in the Kaiser-Permanente system, has shown a greater need for parathyroidectomy than was previously thought. Moreover, such patients had a lower fracture risk with hyperparathyroidectomy and a higher risk of fracture with bisphosphonate use. 

Heretofore, the comparative effectiveness of surgical and medical treatments on fracture risk in primary hyperparathyroidism (PHPT) was unknown.

Patients with a confirmed risk of PHPT between 1995 to 2010, were followed with bone mineral density (BMD) changes and changes in treatment were recorded. Total hip BMD increased transiently in women with parathyroidectomy (4.2% at <2 years) and with bisphosphonate therapy s (3.6% at <2 years) and declined progressively in those not receiving either of these treatments.

In 6272 PTPH patients followed for fracture, the absolute risk for hip fracture at 10 years was 20.4 events per 1000 patients who had parathyroidectomy and 85.5 events per 1000 patients treated with bisphosphonates compared with 55.9 events per 1000 patients without these treatments.

The risk for any fracture at 10 years was 156.8 events per 1000 patients who had parathyroidectomy and 302.5 events per 1000 patients treated with bisphosphonates compared with 206.1 events per 1000 patients without these treatments.

Parathyroidectomy was associated with reduced fracture risk in both osteopenic and osteoporotic patients, whereas bisphosphonates were associated with increased fracture risk in these patients.

Parathyroidectomy was associated with fracture risk reduction in patients regardless of whether they satisfied criteria from consensus guidelines for surgery.