Bone health in medically managed primary hyperparathyroidism

Mairead T Crowley; Eniola Amosu; Ruth Cullen; Maria Byrne; Mensud Hatunic; Brendan Kinsley; Recie Davern; Siobhan McQuaid; Paula M. O; Nigel Glynn

doi:10.1530/endoabs.115.EP45

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Endocrine Abstracts (2026) 115 EP45 | DOI: 10.1530/endoabs.115.EP45

IES2025 Research, Audit and Quality Improvement Projects E-Posters (60 abstracts)

Bone health in medically managed primary hyperparathyroidism

Mairéad T Crowley , Eniola Amosu , Ruth Cullen , Maria Byrne , Mensud Hatunic , Brendan Kinsley , Recie Davern , Siobhán McQuaid , Paula M. O’Shea & Nigel Glynn

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Mater Misericordiae University hospital, Dublin, Ireland

Primary hyperparathyroidism (PHPT) leads to reduced bone mineral density (BMD), particularly at cortical sites. The natural course of parathyroid bone disease without parathyroidectomy remains uncertain. This study aimed to assess the prevalence of reduced BMD in medically managed PHPT, the inclusion of cortical BMD in initial assessment, rates of reassessment, and BMD-targeted treatment. Biochemical features were compared between patients with reduced and preserved BMD. Ninety individuals were identified (mean age 66.3 ± 11.7 years) with mean adjusted calcium; 2.77 ± 0.10 mmol/l/l, PTH; 10.7 ± 4.4 pmol/l, and 25-hydroxyvitamin D; 64 ± 36 nmol/l. Eighty-three patients (92%) underwent DEXA scanning, with cortical bone assessment performed in 52 (63%). Osteoporosis was found in 30 patients (36%) and osteopenia in 37 (45%). Reduced forearm BMD at a single site was detected in 7 patients (14%). No significant differences in age, gender, adjusted calcium, PTH, or initial 25-hydroxyvitamin D levels were observed between those with reduced and preserved BMD (all p>0.05). BMD-targeted therapy was prescribed to 32 patients (36%): 19 received bisphosphonates, 9 denosumab, and 1 anabolic treatment. DEXA reassessment occurred in 39 cases (47%). Patients who underwent reassessment had longer disease duration (P < 0.001), were more likely to be on BMD therapy (P = 0.007), and had lower PTH (P = 0.02) and 25-hydroxyvitamin D (P = 0.04) levels compared to those without reassessment. Parathyroid bone disease is common in medically managed PHPT, and biochemical markers alone do not reliably predict its severity. Including distal forearm BMD assessment is essential for identifying cortical bone involvement.