Decreases in BMD seen before 10 years in patients not treated with parathyroidectomy

Parathyroidectomy led to normalization of biochemical indices and sustained increases in bone mineral density, according to trial findings.

Researchers from Columbia University conducted an observational trial to provide additional insights into patients with primary hyperparathyroidism with and without surgery during 15 years.

Patients (n=116) underwent parathyroidectomy (n=59) or were followed up without surgery (n=57); 91 were women, and 85% were asymptomatic.

Lumbar spine BMD remained stable during the 15 years, according to the researchers. However, before 10 years, BMD decreased by 10% ± 3% (P<.05) at the femoral neck and by 35% ± 5% (P<.05) at the distal radius in asymptomatic patients who did not undergo surgery.

During 15 years, 37% of asymptomatic patients demonstrated disease progression. For patients who underwent surgery, increases in BMD were sustained during the 15 years.

Primary hyperparathyroidism progressed in one-third of patients without surgery; meeting surgical criteria did not predict this progression, according to the researchers.

In the majority of patients with additional observation time points and long-term follow-up, cortical bone density decreased.

“These results raise questions regarding how long patients with primary hyperparathyroidism should be followed up without intervention,” the researchers wrote.

J Clin Endocrinol Metab. 2008;93:3462-3470.