Older adults with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy showed a decreased rate of fractures, according to results of a longitudinal cohort study published in JAMA Internal Medicine.

Medicare fee-for-service claims between 2006 and 2017 were assessed in the study. Patients diagnosed with PHPT were assessed for incidence of fractures on the basis of parathyroidectomy (n=63,136) or nonsurgical (n=147,070) status. To adjust for cohort differences, the investigators used an inverse probability weighted (IPW) propensity matching approach.

The overall cohort was aged 66-75 years (56.1%), 76-85 years (35.0%), or ³86 (8.9%) years; 78.8% were women; 87.3% were White; 51.9% were prefrail, and 43.4% had a history of osteoporosis. Patients who underwent parathyroidectomy were younger compared with those who did not,  were more likely to be White, fewer were frail, and had a lower comorbidity burden.


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During a mean follow-up period of 58.5 (35.5 months), 10.2% and 2.9% of patients treated with parathyroidectomy developed any fracture or hip fracture, respectively, according to the study authors. With a mean follow-up period of 52.5 (33.8 months), 13.7% and 4.2% percent of patients who did not receive a parathyroidectomy developed any fracture or hip fracture, respectively.

Any fracture risk was increased among women (adjusted hazard ratio [aHR], 1.41; 95% CI, 1.36-1.47), those aged ³86 years (aHR, 2.41; 95% CI, 2.32-2.51), with the most disadvantaged area deprivation index (aHR, 1.82; 95% CI, 1.03-1.13), patients who were mildly frail (aHR, 1.98; 95% CI, 1.89-2.07), with Charlson-Deyo Comorbidity Index ³2 (aHR, 1.16; 95% CI, 1.12-1.20), a history of osteoporosis (aHR, 1.66; 1.62-1.71), and prior fracture (aHR, 2.34; 95% CI, 2.26-2.41).

For both any fracture (aHR, 0.78; 95% CI, 0.76-0.80) and hip fracture (aHR, 0.76; 95% CI, 0.72-0.79), parathyroidectomy was associated with decreased risk. On subgroup analysis, there were no significant differences in the association of parathyroidectomy with fracture risk by age group, sex, frailty, history of osteoporosis, or meeting operative guidelines.

In a time-series analysis, parathyroidectomy associated with decreased risk for any fracture at one-year (adjusted risk reduction [aRR], 0.67; 95% CI, 0.52-0.82) and hip fracture at one- (aRR, 0.18; 95% CI, 0.11-0.26) and two- (aRR, 0.36; 95% CI, 0.26-0.46) years post-surgery.

Limitations of the study included the reliance on administrative claims data for analysis; Medicare data lack specific clinical information which would better determine the severity of PHPT or associated complications, according to the investigators.

“Parathyroidectomy was associated with a lower risk of any fracture and hip fracture among older adults with PHPT, suggesting a clinically meaningful benefit of operative management in this population,” the study authors concluded.

Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Seib CD, Meng T, Suh I, et al. Risk of fracture among older adults with primary hyperparathyroidism receiving parathyroidectomy vs nonoperative management. JAMA Intern Med. 2021;e216437. Published online November 29, 2021. doi: 10.1001/jamainternmed.2021.6437.