Primary Hyperparathyroidism and Fracture Risk

Guidelines recommend parathyroidectomy in patients with PHPT and osteoporosis or vertebral fracture (J Clin Endocrinol Metab 2014; 99:3561), however effects of surgery and bisphosphonate therapy on fracture outcomes is unclear.
n = 6272 patients with PHPT and retrospectively looked at skeletal outcomes of parathyroidectomy (22%) vs bisphosphonates (22%) vs observation (55%).
Differences among groups:  bisphosphonate group older, higher proportion with osteoporosis and higher comorbidity scores.
Adjusting for these baseline differences and stratifying for baseline bone-mineral density, parathyroidectomy was associated with lower fracture risk among pts with osteopenia and osteoporosis, whereas bisphosphonates associated with increased fx risk.
Summary:  PHPT patients should preferentially undergo parathyroidectomy if osteopenic or osteoporotic.
Ann Intern Med 2016 Apr 5

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