Positive Effect of Parathyroidectomy Compared to Observation on Bone Mineral Density (BMD) in a Randomized Controlled Trial of Mild Primary Hyperparathyroidism
Authors' conclusion
Because BMD is only a surrogate endpoint of bone health and PTX did not reduce fracture risk, observation could be considered a safe option for many patients with mild PHPT regarding bone health in a 10-year perspective.
Study context
- Population
- Patients with mild PHPT, Scandinavian Investigation of Primary Hyperparathyroidism (SIPH)129 followed 10 years
- Participants
- 191 patients
- Comparison
- Parathyroidectomy vs observation without intervention
- PTXn = 95
- OBSn = 96reference
Methodological details10-year follow-up
- 10-year follow-up
Primary result
As reported in the abstract
BMD (DXA), treatment effect · 10 years
Mean change in T-score from baseline to 10 years greater with PTX than OBS, from 0.41 (radius 33%) to 0.58 (lumbar spine (LS))
0.41–0.58
Further findings
BMD change over time within OBS · 10 years
- Significant decrease in BMD for all compartments in OBS, most pronounced for femoral neck (FN), Rad33 and ultradistal radius (UDR)
- P < 0.001
BMD change over time within PTX · 10 years
- Significant increase in BMD over time only for LS
- P < 0.001
Fracture frequency · 10 years
- No difference between groups in fracture frequency in the 10-year cohort
- Modified intention-to-treat and per protocol analysis
Original publication
Positive Effect of Parathyroidectomy Compared to Observation on BMD in a Randomized Controlled Trial of Mild Primary Hyperparathyroidism. J Bone Miner Res. Published 20 January 2023. doi:10.
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