Focus on Non-osteoporotic Post-menopausal Women with Asymptomatic Primary Hyperparathyroidism: A Monocentric Series

TL;DR

This study examines post-menopausal women with asymptomatic primary hyperparathyroidism who do not have osteoporosis, finding that many do not meet surgical criteria but have similar fracture risks.

Contribution

The study is the first to specifically evaluate asymptomatic PHPT in post-menopausal women without osteoporosis.

Findings

About half of the non-osteoporotic aPHPT patients did not meet surgical criteria.

Patients meeting surgical criteria had higher PTH and calcium levels and lower phosphate and eGFR.

Fracture risk and T scores were similar between surgical and non-surgical groups.

Abstract

Primary Hyperparathyroidism (PHPT) is a common disease, frequently diagnosed in post-menopausal women, among whom Osteoporosis (OP) is a common finding. To date, no study has specifically evaluated the asymptomatic PHPT (aPHPT) patients without OP, in particular post-menopausal women who are exposed to an increased risk of developing OP.

This study involved a retrospective cross-sectional evaluation. From our database of 500 consecutive patients diagnosed with PHPT, 178 post-menopausal aPHPT were retrieved.

The clinical, biochemical, and imaging data of the 85 patients without OP were not different from those of the 93 with OP, except for bone alkaline phosphatase (significantly higher in the latter group). Among these 85 patients without OP, the 45 patients meeting surgical criteria for parathyroidectomy had significantly higher values of serum PTH (240 vs. 99 ng/L, p =0.03) and calcium (total, 11.2 ± 0.7 vs. 10.6 ± 0.4 mg/dL, p <0.001; ionized, 1.45 ± 0.12 vs. 1.36 ± 0.8 mmol/L, p =0.044) and lower values of serum phosphate (2.57 ± 0.7 vs. 2.94 ± 0.5 mg/dL, p =0.009) and eGFR (68.5 ± 23.8 vs 80.8 ± 14.4 mL/min/1.73 m2, p =0.006) than the 40 aPHPT patients not meeting surgical criteria, without any difference in densitometric data and calculated fracture risk.

In our series, post-menopausal aPHPT patients without OP accounted for almost a sixth of the whole PHPT series. About half of these patients did not meet surgical criteria, but their T scores and 10-year fracture risk calculated by FRAX were not significantly different from post-menopausal aPHPT without OP meeting surgical criteria.

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