Risk profile for bone fractures in primary hyperparathyroidism




Contemporary patients with primary hyperparathyroidism (pHPT) have an increased fracture risk, although they are often otherwise asymptomatic with mild hypercalcaemia. Decreased bone density has, therefore, been considered an indication for surgery. However, many patients with pHPT are old with concomitant chronic diseases and therefore have a multifocal risk profile for osteoporosis and bone fractures. The aim of the present study was to evaluate bone density as well as other clinical and biochemical variables of importance for bone metabolism with regard to fracture risk in patients with pHPT.


Two hundred and five consecutive patients, 154 women and 51 men, operated for pHPT were investigated for bone mineral content (BMC), biochemical variables reflecting bone metabolism and severity of pHPT, medication and potential other risk factors for osteoporosis. Mean(s.d.) age of the patients was 64(14) years and serum level of calcium was 2·78(0·18) mmol l−1.


Eighteen patients (9 per cent) had a history of at least one bone fracture during the 5 years before pHPT surgery. In univariate analyses age, BMC, serum level of PTH, 25-hydroxyvitamin D, alkaline phosphatase and collagen telopeptide (ICTP), cortisone treatment and a history of cardiovascular disease were found to be associated with a history of bone fractures. When these variables, and in addition sex, were included in a multiple logistic regression analysis, ICTP was the only variable independently related to bone fractures.


The present data highlight the multifocal bone fracture risk profile in pHPT including low bone density. However, bone resorption (ICTP) was the only variable in the multivariate analysis that was independently associated with bone fractures in pHPT. This finding supports the important role of bone resorption in the pathogenesis of fractures in pHPT. Furthermore, it suggests that ICTP may be a useful tool for risk evaluation of fractures in patients with pHPT. © 2000 British Journal of Surgery Society Ltd