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. 2017 Sep;41(9):2304-2311.
doi: 10.1007/s00268-017-4000-0.

The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism

Elin Isaksson  1   2 , Kerstin Ivarsson  3   4 , Shahriar Akaberi  5   4 , Andreas Muth  6 , Gunnar Sterner  7   8 , Prütz Karl-Göran  9 , Naomi Clyne  5   4 , Martin Almquist  4   10
Affiliations

The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism

Elin Isaksson et al. World J Surg. 2017 Sep.

Abstract

Background: Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of parathyroidectomy.

Design: In a cohort of 20,056 patients on dialysis or with functioning renal allograft, we identified 590 patients who underwent parathyroidectomy between 1991 and 2009. Of these, 579 were matched with 1970 non-PTX patients on age, sex, cause of renal disease and functioning renal allograft or not at the time of PTX or at the corresponding time for non-PTX patients (t). We calculated the risk for hip fracture after PTX using crude and adjusted Cox proportional hazards regressions, adjusting for time in renal replacement therapy before t, time with functioning renal allograft before and after t, comorbidity at t and a hip fracture before t.

Results: The adjusted hazard ratio (95% confidence interval) for hip fracture was 0.40 (0.18-0.88) for PTX patients, compared to non-PTX patients. When analyses were performed separately for sex, only women had a lower risk of hip fracture after PTX compared to non-PTX patients. The risk of hip fracture after PTX was similar in patients with or without functioning renal allograft at time for PTX.

Conclusion: Parathyroidectomy is associated with a lower risk of hip fracture in female patients with secondary hyperparathyroidism.

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Conflict of interest statement

Conflict of interest

There are no financial or other relationships that might lead to any conflict of interest.

Ethical approval

The study was approved by the Regional Ethics Committee of Lund, DNR 483/2010.

Figures

Fig. 1
Fig. 1
Kaplan–Meier hip fracture-free survival estimate for PTX and non-PTX patients. Time in years to first event. Separate graphs for all patients, female and male gender, dialysis at time of PTX, functioning renal transplant at time of PTX, no hip fracture before PTX and hip fracture before PTX. PTX parathyroidectomy
Fig. 2
Fig. 2
Forest plot of Cox proportional hazards (95% CI) over risk of hip fracture after PTX in subgroup analyses cases compared to references. Adjusted for time in RRT before PTX/t, time with a renal transplant before PTX/t, Charlson comorbidity score at PTX/t, time with a renal transplant after PTX/t and hip fracture before PTX/t. PTX parathyroidectomy
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