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. 2025 Jan 28;9(2):bvae225.
doi: 10.1210/jendso/bvae225. eCollection 2025 Jan 6.

Assessing and Managing Primary Hyperparathyroidism and Fracture Risk in England: A Survey of Medical Professionals

Kaiyang Song  1 , Rohit Vijjhalwar  1 , Mo Aye  2 , Alexander N Comninos  3 , Marian Schini  4 , Afroze Abbas  5 , Neil Gittoes  6 , Muhammad Kassim Javaid  7
Affiliations

Assessing and Managing Primary Hyperparathyroidism and Fracture Risk in England: A Survey of Medical Professionals

Kaiyang Song et al. J Endocr Soc. .

Abstract

Purpose: To describe diagnostic approaches and management strategies for patients with primary hyperparathyroidism (PHPT) and recent fracture in England.

Methods: We developed a survey based on a patient at high fracture risk and a new diagnosis of probable PHPT. The survey was circulated among 50 secondary care professionals identified by the Society for Endocrinology Calcium and Bone special interest group. Descriptive statistics, combinatorial, and thematic analyses were employed.

Results: In the patient with hyperparathyroidism and a recent fracture, 54% of respondents favoured a 24-hour urinary calcium: creatinine clearance ratio, with 85% opting to do so after correcting vitamin D levels. Thirty-two percent (16/50) preferred the spot urinary calcium:creatinine clearance ratio, as a random test (56%, n = 9/16). Ninety-six percent of the respondents agreed they would include a fracture risk assessment in their management plan. Eighty-five percent of the respondents selected dual-energy X-ray absorptiometry scans of the lumbar spine, total hip, and femoral neck as the most popular choice. Before initiating antiosteoporotic medications (AOMs), 94% of the respondents preferred correcting vitamin D levels with diverse regimens. IV zoledronate acid was the preferred AOM, and 58% (n = 29/50) supported cinacalcet usage if the patient was ineligible for parathyroid surgery, while 26% (n = 13/50) opposed cinacalcet use entirely. No significant correlation was found between status as an endocrinology consultant or working in a tertiary care hospital and these management preferences.

Main conclusion: This study of National Health Service medical staff identified highly-varied clinical practices in managing PHPT in the setting of high fracture risk, highlighting the need for pragmatic guidelines and wider education.

Keywords: antiosteoporotic medication; fracture; hyperparathyroidism; survey.

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Figures

Figure 1.
Figure 1.
Different combinations of fracture assessment methods for determining fracture risk.
Figure 2.
Figure 2.
Combinatorial analysis of the antiosteoporotic medications endorsed to be initiated by the respondents.
See this image and copyright information in PMC

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