The following is a summary of “Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia,” published in the June 2024 issue of Endocrinology by Frey, et al.

Women with primary hyperparathyroidism (PHPT) often undergo parathyroidectomy due to osteoporosis or bone fractures. However, the effectiveness of surgery in patients with osteopenia, a precursor to osteoporosis, is uncertain. For a study, researchers sought to assess changes in bone mineral density (BMD) and bone remodeling biomarkers one year after parathyroidectomy in women with PHPT.

It was a prospective, monocentric, observational cohort study called the CoHPT cohort, including women with sporadic PHPT who underwent parathyroidectomy in 2016 with at least one year of follow-up. BMD was measured using dual-X-ray absorptiometry, and bone remodeling biomarkers (cross-linked C-telopeptide [CTX], procollagen type 1 N-terminal propeptide [P1NP], and bone-specific alkaline phosphatases) were assessed before and one year after surgery. The study was conducted at a referral center. A total of 177 women with PHPT were included, with an average age of 62.5 years, 83.1% being menopausal, 43.9% classified as osteopenic, and 45.1% as osteoporotic. Parathyroidectomy was performed on the patients. The primary outcome measure was the change in BMD before and one year after parathyroidectomy.

Parathyroidectomy led to a significant increase in BMD and a decrease in serum bone remodeling biomarkers. Among the 72 patients with baseline osteopenia, mean BMD significantly increased at various sites, including the lumbar spine [+0.05 g/cm² (95% CI, 0.03–0.07)], femoral neck [+0.02 g/cm² (95% CI 0.00–0.04)], total hip [+0.02 g/cm² (95% CI 0.01–0.02)], and forearm [+0.01 (95% CI 0.00–0.02)], comparable to patients who are osteoporotic. Patients with osteopenia who showed individual BMD gain (>0.03 g/cm²) at one or more sites had higher preoperative serum CTX, P1NP, and urine calcium concentrations than those without improvement.

Parathyroidectomy significantly improved BMD and remodeling biomarkers in women with osteopenia, supporting the benefit of surgery in these patients. Preoperative serum CTX and P1NP concentrations could be useful predictors of expected BMD gain.

Reference: academic.oup.com/jcem/article-abstract/109/6/1494/7502897