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24-hour Urine Calcium Predicts Reduced Fracture Incidence and Improved Bone Mineral Density After Surgery for Primary Hyperparathyroidism

Nilsson, Martin LU orcid ; Åkesson, Kristina E. LU ; Thier, Mark LU ; Nordenström, Erik LU ; Almquist, Martin LU and Bergenfelz, Anders LU (2024) In Journal of Clinical Endocrinology and Metabolism 109(12). p.2273-2282
Abstract

Context: Contemporary patients with primary hyperparathyroidism are diagnosed with milder disease than previously. Clinical and biochemical factors predictors with an impact on fracture incidence and bone mineral density after surgery have not been firmly established. Objective: To investigate predictors of fracture incidence and bone mineral density preoperatively and after surgery for primary hyperparathyroidism (pHPT). Design: Prospectively collected surgical cohort with matched population controls. Data were cross-linked with the Swedish National Patient Register, the Prescribed Drug Register, and the Cause of Death Register. Setting: Tertiary referral center. Patients or other participants: Seven hundred nine patients with... (More)

Context: Contemporary patients with primary hyperparathyroidism are diagnosed with milder disease than previously. Clinical and biochemical factors predictors with an impact on fracture incidence and bone mineral density after surgery have not been firmly established. Objective: To investigate predictors of fracture incidence and bone mineral density preoperatively and after surgery for primary hyperparathyroidism (pHPT). Design: Prospectively collected surgical cohort with matched population controls. Data were cross-linked with the Swedish National Patient Register, the Prescribed Drug Register, and the Cause of Death Register. Setting: Tertiary referral center. Patients or other participants: Seven hundred nine patients with successful parathyroidectomy for pHPT and 2112 controls matched on sex, age, and municipality were included in the study. Main outcome measures: Fracture incidence, absolute change, and ≥2.77% increase in bone mineral density of femoral neck, L2–L4, and distal third of radius at 1-year follow-up. Results: Patients with pHPT had an increased fracture incidence before surgery but not after pHPT surgery. Fracture incidence after surgery was inversely related to preoperative 24-hour urine calcium (incidence rate ratio for the highest tertile 220– mg/d 0.29, 95% confidence interval 0.11-0.73). Serum and 24-hour urine calcium, parathyroid hormone, osteocalcin, and adenoma weight were all associated with bone mineral density recovery after surgery. Conclusion: Twenty-four-hour urine calcium is the most important biochemical variable to predict a decreased fracture incidence and improved bone mineral density after surgery for pHPT.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adenoma, bone density, bone/epidemiology, calcium, fractures, hyperparathyroidism, primary/complications, primary/surgery
in
Journal of Clinical Endocrinology and Metabolism
volume
109
issue
12
pages
2273 - 2282
publisher
Oxford University Press
external identifiers
  • scopus:85209566668
  • pmid:38412311
ISSN
0021-972X
DOI
10.1210/clinem/dgae106
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.
id
856f9471-6f46-48c4-a26e-d1ea1b3bdd9f
date added to LUP
2025-01-15 14:37:04
date last changed
2025-07-17 05:45:43
@article{856f9471-6f46-48c4-a26e-d1ea1b3bdd9f,
  abstract     = {{<p>Context: Contemporary patients with primary hyperparathyroidism are diagnosed with milder disease than previously. Clinical and biochemical factors predictors with an impact on fracture incidence and bone mineral density after surgery have not been firmly established. Objective: To investigate predictors of fracture incidence and bone mineral density preoperatively and after surgery for primary hyperparathyroidism (pHPT). Design: Prospectively collected surgical cohort with matched population controls. Data were cross-linked with the Swedish National Patient Register, the Prescribed Drug Register, and the Cause of Death Register. Setting: Tertiary referral center. Patients or other participants: Seven hundred nine patients with successful parathyroidectomy for pHPT and 2112 controls matched on sex, age, and municipality were included in the study. Main outcome measures: Fracture incidence, absolute change, and ≥2.77% increase in bone mineral density of femoral neck, L2–L4, and distal third of radius at 1-year follow-up. Results: Patients with pHPT had an increased fracture incidence before surgery but not after pHPT surgery. Fracture incidence after surgery was inversely related to preoperative 24-hour urine calcium (incidence rate ratio for the highest tertile 220– mg/d 0.29, 95% confidence interval 0.11-0.73). Serum and 24-hour urine calcium, parathyroid hormone, osteocalcin, and adenoma weight were all associated with bone mineral density recovery after surgery. Conclusion: Twenty-four-hour urine calcium is the most important biochemical variable to predict a decreased fracture incidence and improved bone mineral density after surgery for pHPT.</p>}},
  author       = {{Nilsson, Martin and Åkesson, Kristina E. and Thier, Mark and Nordenström, Erik and Almquist, Martin and Bergenfelz, Anders}},
  issn         = {{0021-972X}},
  keywords     = {{adenoma; bone density; bone/epidemiology; calcium; fractures; hyperparathyroidism; primary/complications; primary/surgery}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{2273--2282}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of Clinical Endocrinology and Metabolism}},
  title        = {{24-hour Urine Calcium Predicts Reduced Fracture Incidence and Improved Bone Mineral Density After Surgery for Primary Hyperparathyroidism}},
  url          = {{http://dx.doi.org/10.1210/clinem/dgae106}},
  doi          = {{10.1210/clinem/dgae106}},
  volume       = {{109}},
  year         = {{2024}},
}