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The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism

Isaksson, Elin LU ; Ivarsson, Kerstin LU ; Akaberi, Shahriar LU ; Muth, Andreas; Sterner, Gunnar LU ; Karl-Göran, Prütz; Clyne, Naomi LU and Almquist, Martin LU (2017) In World Journal of Surgery p.1-8
Abstract

Background: Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of parathyroidectomy.Design: In a cohort of 20,056 patients on dialysis or with functioning renal allograft, we identified 590 patients who underwent parathyroidectomy between 1991 and 2009. Of these, 579 were matched with 1970 non-PTX patients on age, sex, cause of renal disease and functioning renal allograft or not at the time of PTX or at the corresponding time for... (More)

Background: Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of parathyroidectomy.Design: In a cohort of 20,056 patients on dialysis or with functioning renal allograft, we identified 590 patients who underwent parathyroidectomy between 1991 and 2009. Of these, 579 were matched with 1970 non-PTX patients on age, sex, cause of renal disease and functioning renal allograft or not at the time of PTX or at the corresponding time for non-PTX patients (t). We calculated the risk for hip fracture after PTX using crude and adjusted Cox proportional hazards regressions, adjusting for time in renal replacement therapy before t, time with functioning renal allograft before and after t, comorbidity at t and a hip fracture before t. Results: The adjusted hazard ratio (95% confidence interval) for hip fracture was 0.40 (0.18–0.88) for PTX patients, compared to non-PTX patients. When analyses were performed separately for sex, only women had a lower risk of hip fracture after PTX compared to non-PTX patients. The risk of hip fracture after PTX was similar in patients with or without functioning renal allograft at time for PTX. Conclusion: Parathyroidectomy is associated with a lower risk of hip fracture in female patients with secondary hyperparathyroidism.

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publication status
epub
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in
World Journal of Surgery
pages
1 - 8
publisher
Springer
external identifiers
  • scopus:85016039502
ISSN
0364-2313
DOI
10.1007/s00268-017-4000-0
language
English
LU publication?
yes
id
d9ab960e-166d-4c1a-9bf9-247b9d2892d6
date added to LUP
2017-05-03 16:44:34
date last changed
2017-05-03 16:44:34
@article{d9ab960e-166d-4c1a-9bf9-247b9d2892d6,
  abstract     = {<p>Background: Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of parathyroidectomy.Design: In a cohort of 20,056 patients on dialysis or with functioning renal allograft, we identified 590 patients who underwent parathyroidectomy between 1991 and 2009. Of these, 579 were matched with 1970 non-PTX patients on age, sex, cause of renal disease and functioning renal allograft or not at the time of PTX or at the corresponding time for non-PTX patients (t). We calculated the risk for hip fracture after PTX using crude and adjusted Cox proportional hazards regressions, adjusting for time in renal replacement therapy before t, time with functioning renal allograft before and after t, comorbidity at t and a hip fracture before t. Results: The adjusted hazard ratio (95% confidence interval) for hip fracture was 0.40 (0.18–0.88) for PTX patients, compared to non-PTX patients. When analyses were performed separately for sex, only women had a lower risk of hip fracture after PTX compared to non-PTX patients. The risk of hip fracture after PTX was similar in patients with or without functioning renal allograft at time for PTX. Conclusion: Parathyroidectomy is associated with a lower risk of hip fracture in female patients with secondary hyperparathyroidism.</p>},
  author       = {Isaksson, Elin and Ivarsson, Kerstin and Akaberi, Shahriar and Muth, Andreas and Sterner, Gunnar and Karl-Göran, Prütz and Clyne, Naomi and Almquist, Martin},
  issn         = {0364-2313},
  language     = {eng},
  month        = {03},
  pages        = {1--8},
  publisher    = {Springer},
  series       = {World Journal of Surgery},
  title        = {The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism},
  url          = {http://dx.doi.org/10.1007/s00268-017-4000-0},
  year         = {2017},
}