Secular trends in the incidence of primary hyperparathyroidism over five decades (1965-2010)

Abstract

Introduction of automated serum calcium measurements in the 1970s resulted in a sharp rise in primary hyperparathyroidism (PHPT) incidence. However, recent investigations suggest a significant rise in PHPT incidence for unclear reasons. Our objective was to update our population-based secular trends in PHPT incidence, to determine if there has been a significant rise in PHPT incidence as suggested by others, and, if possible, to identify changes in clinical practice that might be responsible. Rochester, Minnesota, residents who met the criteria for PHPT from 2002 through 2010 were identified through the medical records-linkage system of the Rochester Epidemiology Project and added to the historical cohort beginning in 1965. Incidence rates were adjusted to the 2010 US white population. Altogether, 1142 Rochester residents have been diagnosed with PHPT since 1965, including 341 in 2002-2010. Over time, two periods of increased PHPT incidence occurred, one beginning in 1974 (121.7 per 100,000 person-years) and a second peak (86.2 per 100,000 person-years) starting in 1998. The median age of PHPT subjects has increased significantly from 55 years in 1985-1997 to 60 years of age in 1998-2010 and more patients (36%) had a parathyroidectomy in 1998-2010. Although serum calcium measurement has declined since 1996, there was a progressive increase in parathyroid hormone testing between 1994 and 2008. There was also a rise in orders for bone mineral density measurements in women since 1998, which peaked in 2003-2004. A second sharp rise in PHPT incidence occurred in our community in 1998, simultaneously with the introduction of national osteoporosis screening guidelines, Medicare coverage for bone density measurement, and new medications for the treatment of osteoporosis. Case ascertainment bias from targeted PHPT screening in patients being evaluated for osteoporosis is the most likely explanation.

Keywords: Epidemiology; Hypercalcemia; Incidence; Osteoporosis; Primary hyperparathyroidism.

Figure 1

Age-adjusted (to 2010 U.S. whites) incidence of definite (solid line) and possible (dashed line) primary hyperparathyroidism (upper panel) and women (solid line) and men (dashed line) with primary hyperparathyroidism (lower panel), among Rochester, Minnesota, residents, 1965-2010.

Figure 2

Utilization of serum calcium (panel A) and PTH (panel B) measurements from 1994 to 2010 and bone mineral density unique patient orders (panel C) from 1998 to 2010 at Mayo Clinic Rochester for all Olmsted County, Minnesota, residents.