Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;163(1):17-21.
doi: 10.1016/j.surg.2017.04.045. Epub 2017 Nov 3.

Skeletal effects of failed parathyroidectomy

Feibi Zheng  1 , Hui Zhou  2 , Ning Li  3 , Philip I Haigh  4 , Annette L Adams  2 , Michael W Yeh  5
Affiliations

Skeletal effects of failed parathyroidectomy

Feibi Zheng et al. Surgery. 2018 Jan.

Abstract

Background: Parathyroidectomy improves bone mineral density and decreases risk for fracture in patients with primary hyperparathyroidism. The aim of this study was to determine skeletal consequences of failed parathyroidectomy.

Methods: A retrospective, cohort study of patients with biochemically confirmed primary hyperparathyroidism within a vertically integrated health system was performed (1995-2014). Failed parathyroidectomy was defined by hypercalcemia within 6 months of initial parathyroidectomy. Time-varying Cox regression was used to estimate the risk for any fracture and hip fracture in 3 comparison groups: observation, successful parathyroidectomy, and failed parathyroidectomy. Bone mineral density changes also were compared.

Results: The cohort included 7,169 patients, of whom 5,802 (81%) were observed, 1,228 underwent successful parathyroidectomy (17%), and 137 underwent failed parathyroidectomy (2%). The adjusted risk for any fracture (hazard ratio, 1.28; 95% confidence interval, 0.85-1.92) and hip fracture (hazard ratio, 1.63; 95% CI, 0.77-3.45) associated with failed parathyroidectomy was similar to that associated with observation. Successful parathyroidectomy was associated with a decrease in any fracture (hazard ratio, 0.68; 95% confidence interval, 0.57-0.82) and hip fracture (hazard ratio, 0.43; 95% confidence interval, 0.27-0.68) compared with observation. Bone mineral density changes in the failed parathyroidectomy group paralleled those associated with observation.

Conclusion: Failed parathyroidectomy is associated with a high risk for fracture similar to that seen with observation.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
Flow chart depicting observation, successful parathyroidectomy, and failed parathyroidectomy groups and fracture rates.
Fig 2.
Fig 2.
Bone mineral density changes over baseline. Error bars represent 95% confidence intervals.
See this image and copyright information in PMC

Comment in

  • Editorial: "Skeletal effects of failed parathyroidectomy".
    Marcadis AR, Lew JI. Marcadis AR, et al. Surgery. 2018 Jan;163(1):22. doi: 10.1016/j.surg.2017.09.016. Epub 2017 Nov 3. Surgery. 2018. PMID: 29108704 No abstract available.
  • Discussion.
    [No authors listed] [No authors listed] Surgery. 2018 Jan;163(1):20-21. doi: 10.1016/j.surg.2017.04.052. Epub 2017 Nov 3. Surgery. 2018. PMID: 29108706 No abstract available.

References

    1. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 2013;98:1122–9. - PMC - PubMed
    1. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016:151:959–68. - PubMed
    1. Yeh MW, Zhou H, Adams AL, et al. The relationship of parathyroidectomy and bisphosphonates with fracture risk in primary hyperparathyroidism: an observational study. Ann Intern Med 2016:164:715–23. - PubMed
    1. Abdulla AG, Ituarte PH, Harari A, Wu JX, Yeh MW, Trends in the frequency and quality of parathyroid surgery: analysis of 17,082 cases over 10 years. Ann Surg 2015:261:746–50. - PubMed
    1. Udelsman R Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665–72. - PMC - PubMed

Publication types