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Reduced fracture incidence in patients having surgery for primary hyperparathyroidism

Nilsson, Martin LU orcid ; Ståhl, Elin LU ; Åkesson, Kristina E. LU ; Thier, Mark LU ; Nordenström, Erik LU ; Almquist, Martin LU and Bergenfelz, Anders LU (2022) In Clinical Endocrinology 97(3). p.276-283
Abstract

Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively... (More)

Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre- and postoperatively were tabulated and evaluated with mixed-effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression. Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross-linked with Statistics Sweden and the National Board of Health and Welfare. Measurements: Preoperative serum calcium and adenoma weight at pathological examination. Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence. Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adenoma, bone/epidemiology, calcium, fractures, hyperparathyroidism, primary/complications, primary/surgery
in
Clinical Endocrinology
volume
97
issue
3
pages
276 - 283
publisher
Wiley-Blackwell
external identifiers
  • scopus:85125594589
  • pmid:35192220
ISSN
0300-0664
DOI
10.1111/cen.14703
language
English
LU publication?
yes
id
7a274225-51f0-40e2-a613-1453684f3977
date added to LUP
2022-04-26 12:21:40
date last changed
2024-05-02 08:20:44
@article{7a274225-51f0-40e2-a613-1453684f3977,
  abstract     = {{<p>Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre- and postoperatively were tabulated and evaluated with mixed-effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression. Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross-linked with Statistics Sweden and the National Board of Health and Welfare. Measurements: Preoperative serum calcium and adenoma weight at pathological examination. Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence. Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.</p>}},
  author       = {{Nilsson, Martin and Ståhl, Elin and Åkesson, Kristina E. and Thier, Mark and Nordenström, Erik and Almquist, Martin and Bergenfelz, Anders}},
  issn         = {{0300-0664}},
  keywords     = {{adenoma; bone/epidemiology; calcium; fractures; hyperparathyroidism; primary/complications; primary/surgery}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{276--283}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Endocrinology}},
  title        = {{Reduced fracture incidence in patients having surgery for primary hyperparathyroidism}},
  url          = {{http://dx.doi.org/10.1111/cen.14703}},
  doi          = {{10.1111/cen.14703}},
  volume       = {{97}},
  year         = {{2022}},
}