Surgery versus observation in patients 65 years or older with primary hyperparathyroidism: randomized clinical trial
Abstract
Background: A substantial portion of surgically treated patients with primary hyperparathyroidism (pHPT) are older than 65 years. The indication for parathyroidectomy in older patients with pHPT and mild hypercalcaemia is unclear. Specifically, it is not known whether parathyroid surgery improves bone mineral density (BMD) in this age group.
Method: Patients 65 years or older with pHPT, ionized calcium not exceeding 1.50 mmol/l, and a BMD Z-score above -2.5 standard deviations who were referred to the Department of Surgery, Lund University Hospital, were included in the study. Follow-up was performed over 2 years. The random allocation sequence to surgery or observation was computer generated. There was no blinding. Primary outcome was BMD of the hip, with the primary endpoint being the change in total hip BMD from baseline to the end of follow-up. Secondary outcome was BMD of the lumbar spine. Continuous variables were analysed using Satterthwaite's t-test. Intention-to-treat analysis of change from baseline was performed using a mixed-model repeated-measures ANOVA (MMRM ANOVA).
Results: A total of 255 patients were screened and 102 were randomized: 50 to observation and 52 to surgery. The median age was 71 (range 65-85) years. For analysis of the primary endpoint, 41 patients in the surgery group and 40 in the observation group were available. Total hip BMD at 2 years increased by a mean of 1.3% (95% confidence interval -0.2% to 2.8%) in the surgery group and decreased by…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 255 participants or records.
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.