USA: Parathyroidectomy versus nonoperative management is related to a lower risk of any fracture and hip fracture in older adults with primary hyperparathyroidism (PHPT), a recent study has found. The findings, published in JAMA Internal Medicine, suggest a clinically meaningful benefit of operative management in this population.
PHPT, a common endocrine disorder, is a contributor to the development and progression of osteoporosis in older adults. However, the effectiveness of parathyroidectomy for reducing fracture risk in older adults is not known. Carolyn D. Seib, Stanford University School of Medicine, Stanford, California, and colleagues aimed to compare the incidence of clinical fracture among older adults with PHPT treated with parathyroidectomy vs nonoperative management.
The research was designed as a population-based, longitudinal cohort study of all Medicare beneficiaries with PHPT from 2006 to 2017. The association of parathyroidectomy vs nonoperative management with incident fracture was determined. Data analysis was conducted from February 17, 2021, to September 14, 2021.
The primary outcome was a clinical fracture at any anatomic site not associated with major trauma during the follow-up period.
Among the 210 206 Medicare beneficiaries with PHPT (mean age, 75 years; 78.8% women; 87.3% White individuals), 63 136 (30.0%) underwent parathyroidectomy within 1 year of diagnosis, and 147 070 (70.0%) were managed nonoperatively.
The study revealed the following:
During a mean follow-up period of 58.5 months, the unadjusted incidence of fracture was 10.2% in patients treated with parathyroidectomy.
During a mean follow-up of 52.5 months, the unadjusted incidence of fracture was 13.7% in patients observed nonoperatively.
On multivariable analysis, parathyroidectomy was associated with lower adjusted rates of any fracture (hazard ratio [HR], 0.78) and hip fracture (HR, 0.76).
At 2, 5, and 10 years, parathyroidectomy was associated with an adjusted absolute fracture risk reduction of 1.2%, 2.8%, and 5.1% respectively, compared with nonoperative management.
On subgroup analysis, there were no significant differences in the association of parathyroidectomy with fracture risk by age group, sex, frailty, history of osteoporosis, or meeting operative guidelines.
Fine-Gray competing risk regression confirmed parathyroidectomy was associated with a lower probability of any fracture and hip fracture when accounting for the competing risk of death (HR, 0.84 and HR, 0.83 respectively).
"Based on these findings, low utilization of parathyroidectomy in older adults requires further evaluation to guide focused interventions that target parathyroidectomy to older adults likely to benefit," concluded the authors.
Reference:
Seib CD, Meng T, Suh I, et al. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. Published online November 29, 2021. doi:10.1001/jamainternmed.2021.6437