Primary Hyperparathyroidism Screening Needs Improvement

CHICAGO — More patients with documented bone disease should undergo screening for primary hyperparathyroidism, according to new research.

“All patients who demonstrate abnormal bone mineral density should be screened for [primary hyperparathyroidism],” researchers from the University of Washington wrote in an abstract presented at ICE/ENDO 2014, the joint meeting of the International Congress of Endocrinology and the Endocrine Society.

To evaluate the frequency with which patients with osteoporosis or osteopenia undergo screening for primary hyperparathyroidism, the researchers conducted an in-depth chart review of patients who received a diagnosis of osteopenia or osteoporosis at their institution in 2011. A random sample of every fifth patient with a primary care physician in the researchers’ health system was included in the analysis.

The researchers considered adequate screening for primary hyperparathyroidism as drawing of serum calcium within 6 months of the diagnostic bone density scan. Frequency of parathyroid hormone testing and the extent of work-up for abnormal results were also assessed.

Of 450 patients (women, 90.9%; mean age, 50.5 years) included in the study, mean T score was –1.91. Eighty-seven patients (19.3%) had osteoporosis and 363 (80.7%) had osteopenia.

In 234 patients (52%), health care providers checked serum calcium levels within 6 months of diagnosis. Patients with osteoporosis, as compared with osteopenia, were significantly more likely to undergo screening (71.2% vs. 47.6%; P<.001).

A total of 413 patients (91.8%) had calcium levels available at any timepoint after diagnosis. Thirty-two patients (7.7%) had calcium levels higher than 10.2 mg/dL, according to the data. Parathyroid hormone levels, however, were only obtained in 17 (53%) of these patients with hypercalcemia and bone disease. Results showed that 12 had confirmed hyperparathyroidism and four were referred for parathyroidectomy.

Only 38 patients (8.4%) were referred to an endocrinologists, with the majority having PCPs manage their bone disease. Those under an endocrinologist’s care were significantly more likely to have a calcium level (100% vs. 18.7%; P<.001) and a parathyroid hormone level (84.2% vs. 21.3%; P<.0001).

Additionally, PCPS were more likely to draw a parathyroid hormone level when the patient was diagnosed with osteoporosis as opposed to osteopenia (32.3% vs. 19.1%; P=.0167). The researchers, however, did not observe this difference with endocrinologists.

“Improved education targeting primary care providers is needed to improve screening for primary hyperparathyroidism in patients with osteopenia and osteoporosis,” the researchers wrote.

Reference

1. McKenney RL et al. Poster SUN-0208. Presented at: ICE/ENDO 2014; June 20-24, 2014; Chicago, IL.