Does parathyroidectomy reduce the risk of fractures and renal stones? Results of a systematic review and meta analysis
BE Sanders, M Davies & PL Selby
Primary hyperparathyroidism (PHP) is a common endocrine condition. The associated metabolic abnormalities are usually amenable to surgical treatment (PTX). Although it is generally believed that such treatment will reduce the risk of long-term complications this has not been demonstrated in a clinical trial and the current treatment guidelines are based on consensus. In order to assess the effect of parathyroidectomy on two of the most common complications of PHP, renal stones and fractures, we have undertaken a systematic review and meta analysis.
Relevant literature was sought by searching electronic databases supplemented by the reference lists of relevant studies.
Six cohort studies reporting fracture rates in patients who had been subject to PTX were identified. Four of these gave unique data and were included in a meta analysis. This indicated that parathyroidectomy was associated with a 10% reduction in fracture risk. However this change was not statistically significant (RR 0.90 [95% CI 0.781.04]).
Four similar cohorts reported renal stone occurrence with and without PTX. Surprisingly meta analysis suggested that PTX was associated with a doubling of stone risk (RR 1.86 [95% CI 1.222.85]). 11 studies examined stone occurrence before and after PTX. All of these reported lower rates following surgery than before although the heterogeneity of reporting made it impossible to undertake a formal meta analysis. We believe that the apparent increase inferred from cohort studies reflects the well-known increased risk of recurrent stone in someone who has already suffered a stone episode coupled with the fact that someone with PHP and stones is more likely to be offered PTX than someone who has no stone disease.
We therefore conclude that the literature offers only limited support to the beneficial effects of parathyroidectomy and that a formal assessment using a randomised controlled study would be justified.