Endocrine Abstracts

Primary hyperparathyroidism (PHPT) is associated with reduced bone mineral density (BMD), particularly at cortical sites. Parathyroidectomy is the definitive treatment and may result in partial recovery of bone mass. Aa 74-year-old female diagnosed with PHPT underwent successful parathyroidectomy. Pre-operative dual-energy X-ray absorptiometry (DEXA) demonstrated osteoporosis with T-scores of –2.8 at the lumbar spine, –2.5 at the left femoral neck and hip, and –4.6 at the left forearm. The multidisciplinary consensus was to monitor her bone density post-operatively without immediate pharmacological osteoporosis therapy, with reassessment at 2 years. Repeat DEXA in 2025 showed improvement: lumbar spine T-score –2.4, femoral neck and hip T-score –2.3, and forearm T-score –4.5. The forearm measurement remained stable but was not considered clinically significant, as treatment decisions were not based on forearm BMD. This case highlights the potential for improvement in BMD at trabecular and mixed skeletal sites following curative parathyroidectomy in PHPT, supporting a conservative approach with re-evaluation before initiating additional osteoporosis therapy.

Questions: 1. After curative parathyroidectomy in PHPT with osteoporosis, should bone-specific therapy be started immediately or delayed until reassessment? 2. What is the optimal timing for repeat DEXA after curative parathyroidectomy? 3. What is the recommended calcium/vitamin D supplementation strategy post-parathyroidectomy in older patients with osteoporosis?