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Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism

Journal article
Authors Karolina Lundstam
Ansgar Heck
Charlotte Mollerup
Kristin Godang
Marek Baranowski
Ylva Pernow
Jan Erik Varhaug
Ola Hessman
Thord Rosén
Jörgen Nordenström
Svante Jansson
Mikael Hellström
Jens Bollerslev
Published in The Journal of clinical endocrinology and metabolism
Volume 100
Issue 4
Pages 1359-1367
ISSN 1945-7197
Publication year 2015
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Radiology
Pages 1359-1367
Language en
Links dx.doi.org/10.1210/jc.2014-3441
Subject categories Endocrine surgery

Abstract

Context: Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed. Objective: To study the effect of parathyroidectomy (PTX) compared with observation (OBS) on biochemistry, safety, bone mineral density (BMD), and new fractures. Design: Prospective, randomized controlled study (SIPH study), 5-year follow-up. Setting: Multicenter, tertiary referral centers. Patients: Of 191 randomized patients with mild PHPT, biochemical data were available for 145 patients after 5 years, mean age at inclusion 62.8 years (OBS group, 9 males) and 62.1 years (PTX group, 10 males). Intervention: Parathyroidectomy vs observation. Main outcome measures: Biochemistry, BMD and new radiographic vertebral fractures. Results: Serum-calcium and PTH-levels normalized after surgery and did not deteriorate by observation. BMD Z-scores were normal at inclusion in the lumbar spine (LS) and femoral neck (FN). For LS, BMD Z-scores were stable for 5 years with observation, but decreased in FN (P<0.02). After surgery, BMD Z-scores increased significantly in both compartments (P<0.02 for both), with a highly significant treatment effect of surgery compared to observation (P<0.001). During follow-up, 5 new clinically unrecognized vertebral fractures were found in 5 females, all in the OBS group (P=0.058). Conclusion: Even though new vertebral fractures occurred only in the observation group, the frequency was not significantly different from the surgery group. Longer follow-up is needed before firm conclusions can be drawn about the long-term safety of observation, as opposed to surgery.

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