Bone mineral density over ten years after primary parathyroidectomy in multiple endocrine neoplasia type 1

Abstract

Primary hyperparathyroidism (PHPT) associated with multiple endocrine neoplasia type 1 (MEN1) impairs bone mineral density and causes osteoporosis already in young patients. We aimed to investigate bone mineral density (BMD) in a contemporary cohort of patients with MEN1-related PHPT after long-term follow-up and compare these results with that of healthy controls. Thirty-five patients with genetically confirmed MEN1 were diagnosed with MEN1 at mean age 28.7 ± 13.6 years. Thirty-two (91.4%) underwent primary parathyroidectomy at mean age 33.3 ± 13.7 years; 12 had undergone at least 2 surgeries with on average 7.3 ± 5.9 years between the operations. BMD was assessed by DXA at the end of mean follow-up, 13.2 years after the primary parathyroidectomy and compared with that of 35 age- and gender-matched controls. More than 10 years after the first parathyroidectomy, mean BMD in patients with MEN1 is in the normal range. However, it is still significantly lower compared with healthy controls.

Keywords: Dxa; Men1; Pth/vit d/fgf23; osteoporosis; parathyroid-related disorders.

Graphical Abstract

Figure 1

A) Age at genetic diagnosis of MEN1 and age at diagnosis of PHPT in patients with MEN1. The median age at which half of the patients were diagnosed was 23.0 years for MEN1 and 28.3 years for PHPT (dashed lines). B) Kaplan–Meier estimate of surgical operations for PHPT in patients with MEN1. The dashed line denotes the estimate for the age at which half of the patients have received surgery.

Figure 2

Boxplots comparing BMD in the femoral neck, total hip, and lumbar spine in patients with MEN1 and healthy controls. p-value for comparison between groups is shown above the plots.