Endocrine Abstracts

JOINT3571

Background: Primary hyperparathyroidism (PHPT) leads to hypercalcemia and increased fracture risk due to parathyroid hormone overproduction. While surgery is the standard curative treatment, optimal bone health management strategies remain unclear. This study evaluates real-world bone mineral density (BMD) changes, fracture risk and treatment in PHPT patients undergoing surgical, medical, or monitoring-based management.

Methods: A retrospective analysis was conducted on patients diagnosed with PHPT between 2012-2019. Data collected included demographics, PHPT management, baseline and longitudinal BMD, fracture risk (assessed with Fracture Risk Assessment Tool, FRAX), and osteoporosis management. Statistical analysis was performed using Prism software.

Results: A total of 758 patients (81% female, mean age 65 ± 16 years) were included. Of these, 52% underwent parathyroidectomy, 14% received long-term cinacalcet (medical group), and 34% were monitored without active treatment. Baseline BMD at the spine, hip, and wrist was comparable across groups (wrist BMD: 0. 68 ± 0. 2 g/cm² vs. 0. 67 ± 0. 1 g/cm² vs. 0. 68 ± 0. 2 g/cm²; P > 0. 9). Mean follow-up duration for repeat DXA was 2. 8 years. The monitored cohort had the highest baseline major osteoporotic fracture (MOF) risk (35 ± 21%) compared to the medical (16. 3 ± 0. 1%, P < 0. 001) and surgical groups (16 ± 0. 2%, P < 0. 001). Hip fracture risk was highest in the monitored group (12. 7 ± 7%) compared to the medical (6. 7 ± 0. 1%, P < 0. 001) and surgical groups (4. 8 ± 0. 2%, P < 0. 001). On repeat DXA, the surgical group demonstrated the greatest BMD gains at all sites: Spine BMD change: +3. 1% (surgical) vs. -2. 78% (medical) vs. -0. 91% (monitored), P < 0. 001. Hip BMD change: +1. 18% (surgical) vs. -5. 69% (medical) vs. -3. 87% (monitored), P < 0. 001. Wrist BMD change: +4. 71% (surgical) vs. -4. 71% (medical) vs. -6. 17% (monitored), P < 0. 001. There were no significant differences in BMD changes between the medical and monitored groups. As per National Osteoporosis Guideline Group thresholds, high/very high fracture risk was identified in 43% (medical & monitored) vs. 31% (surgical) of patients, p < 0. 02. Despite this, only 42% (surgical), 57% (medical), and 56% (monitored) received osteoporosis treatment, indicating suboptimal management.

Conclusion: In this large cohort, surgical treatment resulted in significant BMD improvements at all sites, with the greatest gains at the wrist. No differences were observed between the medical and monitored groups, suggesting cinacalcet alone is insufficient to improve bone health in PHPT. A more proactive osteoporosis management strategy is needed, particularly for non-surgical cohorts.