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- Title
Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism.
- Authors
Lundstam, Karolina; Heck, Ansgar; Mollerup, Charlotte; Godang, Kristin; Baranowski, Marek; Pernow, Ylva; Varhaug, Jan Erik; Hessman, Ola; Rosén, Thord; Nordenström, Jörgen; Jansson, Svante; Hellström, Mikael; Bollerslev, Jens; SIPH Study Group
- Abstract
<bold>Context: </bold>Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed. <bold>Objective: </bold>To study the effect of parathyroidectomy (PTX) compared with observation (OBS) on biochemistry, safety, bone mineral density (BMD), and new fractures. <bold>Design: </bold>Prospective, randomized controlled study (SIPH study), with a 5-year follow-up. <bold>Setting: </bold>The study was conducted at multicenter, tertiary referral centers. <bold>Patients: </bold>Of 191 randomized patients with mild PHPT, biochemical data were available for 145 patients after 5 years, with a mean age at inclusion of 62.8 years (OBS group, 9 males) and 62.1 years (PTX group, 10 males). <bold>Intervention: </bold>Parathyroidectomy vs observation. <bold>Main Outcome Measures: </bold>Biochemistry, BMD, and new radiographic vertebral fractures. <bold>Results: </bold>Serum-calcium and PTH-levels normalized after surgery and did not deteriorate by observation. BMD Z-scores were normal at inclusion in the lumbar spine (LS) and femoral neck (FN). For LS, BMD Z-scores were stable for 5 years with observation, but decreased in FN (P < .02). After surgery, BMD Z-scores increased significantly in both compartments (P < .02 for both), with a highly significant treatment effect of surgery compared to observation (P < .001). During follow-up, five new clinically unrecognized vertebral fractures were found in 5 females, all in the OBS group (P = .058). <bold>Conclusion: </bold>Even though new vertebral fractures occurred only in the observation group, the frequency was not significantly different from the surgery group. Longer follow-up is needed before firm conclusions can be drawn about the long-term safety of observation, as opposed to surgery.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2015, Vol 100, Issue 4, p1359
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2014-3441