SFEBES2022 Poster Presentations Bone and Calcium (40 abstracts)
Post-Operative Bone Health Assessment and Optimisation Remains Suboptimal in Primary Hyperparathyroidism
Ali Al Jumaah 1,2 , Luqman Safwan 1 , Kofi Antwi 1 , Sajnin Zaman 1 , Peter Conboy 1 , Faizanur Rahman 1,2 , Prashanth Patel 1,2 , Shailesh Gohil 1,2 , Ragini Bhake 1 , Miles Levy 1,2 & Narendra Reddy 1,2
1University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 2University of Leicester, Leicester, United Kingdom
Background: One of the main indications for parathyroidectomy surgery in primary hyperparathyroidism (PHPT) is osteoporosis. NICE guideline recommends 2-3 yearly Dual-energy X-ray absorptiometry (DEXA) assessments to evaluate bone mineral density (BMD) in asymptomatic PHPT.
Objective: We undertook an audit to evaluate bone health practice in PHPT patients in line with NICE guidelines.
Methodology: Retrospective case notes and electronic records’ review was undertaken to identify PHPT patients in University Hospitals of Leicester.
Results: n=121 (106F:15M) patients with PHPT & Osteoporosis (T-score < -2.5) or osteopenia (T-score <- 1.0 to -2.5) were identified between 1987 and 2022; 88% were females. Mean age: 61 years at diagnosis, Mean Adjusted calcium 2.76 mmol/l (2.12-2.51), Mean Parathormone 21.22 pmol/l (2-8.5). 104/121 (86%) had DEXA at diagnosis: 37% Osteopenia and 63% had Osteoporosis; 20/121 (16%) had fragility fractures. 57 (47%) were treated surgically achieving cure rate in 51 patients (90%); Adjusted calcium 2.78 mmol/l normalised to 2.39 mmol/l post-surgically. Of those, only 23 (40%), had at least one DEXA performed after parathyroidectomy. Mean T-scores improved from -2.74 to -2.17 from osteoporosis to osteopenia range post-surgically indicating BMD improvement. Of the 64/121 non-surgically-treated patients 7 (11%) had at least one DEXA repeated within 3 years. 30/64 (47%) of non-surgical patients received medical treatment for osteoporosis. Interestingly 24/57 (42%) of surgically excised parathyroid adenomas were localised the right inferior location.
Discussion: Although immediate improvement in T-scores were noted post-surgically, assessment of BMD and Osteoporosis treatment remained suboptimal. We intend to address this with a quality improvement project undertaken prospectively as a result of this audit.
Conclusion: 1. Long term bone health assessment and treatment remains vital irrespective of PHPT surgery as it takes time to improve BMD even after surgery. 2. Patient education, prevention/treatment of osteoporosis, strict specialist monitoring such as DEXA evaluations is recommended.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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