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
. 2022 Sep;97(3):276-283.
doi: 10.1111/cen.14703. Epub 2022 Mar 4.

Reduced fracture incidence in patients having surgery for primary hyperparathyroidism

Martin Nilsson  1   2 , Elin Ståhl  3   4 , Kristina E Åkesson  4   5 , Mark Thier  1   2 , Erik Nordenström  1   2 , Martin Almquist  1   2 , Anders Bergenfelz  1   2
Affiliations

Reduced fracture incidence in patients having surgery for primary hyperparathyroidism

Martin Nilsson et al. Clin Endocrinol (Oxf). 2022 Sep.

Abstract

Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence.

Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre- and postoperatively were tabulated and evaluated with mixed-effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression.

Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross-linked with Statistics Sweden and the National Board of Health and Welfare.

Measurements: Preoperative serum calcium and adenoma weight at pathological examination.

Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11-1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence.

Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.

Keywords: adenoma; bone/epidemiology; calcium; fractures; hyperparathyroidism; primary/complications; primary/surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence rate ratio (IRR) of any fracture pre‐ and postoperatively. CI, confidence interval [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. National Patient Register, Online Statistical Database . Accessed May 17, 2021. https://sdb.socialstyrelsen.se/if_ope/val.aspx
    1. Minisola S, Gianotti L, Bhadada S, Silverberg SJ. Classical complications of primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018;32(6):791‐803. - PubMed
    1. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018;14(2):115‐125. - PMC - PubMed
    1. Palmer M, Adami HO, Krusemo UB, Ljunghall S. Increased risk of malignant diseases after surgery for primary hyperparathyroidism. A nationwide cohort study. Am J Epidemiol. 1988;127(5):1031‐1040. - PubMed
    1. Larsson K, Ljunghall S, Krusemo UB, Naessen T, Lindh E, Persson I. The risk of hip fractures in patients with primary hyperparathyroidism: a population‐based cohort study with a follow‐up of 19 years. J Intern Med. 1993;234(6):585‐593. - PubMed

Publication types