Endocrine Abstracts

Objective: Whereas parathyroidectomy (PTx) has an established benefit in patients with symptomatic primary hyperparathyroidism (PHPT), its efficacy in patients with mild (asymptomatic) PHPT has not been proven. The aim of this study was to systematically investigate and meta-analyze the best available evidence from randomized-controlled trials regarding the efficacy of PTx on fracture risk (primary endpoint), as well as bone mineral density (BMD), serum calcium concentrations, nephrolithiasis risk and quality of life (QoL) (secondary endpoints) compared with conservative management (non-PTx; pharmaceutical intervention or active surveillance) in patients with mild PHPT.

Methods: A comprehensive literature search was conducted in PubMed, Scopus and Cochrane, from conception to January 11th, 2020. Data were expressed as percentage mean differences with 95% confidence intervals (CI). The I2 index was employed for heterogeneity.

Results: Five studies (four with active surveillance, one with etidronate) fulfilled the eligibility criteria [334 patients, mean age 66.5 ± 5.6 years, mean follow-up time 25.2 (range 6–60) months]. There was no difference in fracture incidence between non-PTx and PTx patients [relative risk (RR) for total fractures 2.93 (95% CI 0.91, 9.49), I2 = 0%; RR for vertebral fractures 5.66 (95% CI 0.68, 47.31), I2 = 0%; RR for non-vertebral fractures: 1.32 (95% CI 0.31, 5.67), I2 not applicable)]. Lower BMD values were demonstrated in non-PTx compared with PTx patients [mean difference in lumbar spine BMD −4.53% (95% CI −6.25, −2.81), I2 = 98%; femoral neck BMD -2.89% (95% CI -5.71, −0.06), I2 = 100%; total hip BMD −3.44% (95% CI −5.49, −1.39), I2 = 99%; forearm BMD: no difference]. With respect to serum calcium concentrations, PTx patients demonstrated a mean reduction of 10.8% (95% CI 9.1, 12.6, I2 = 98%) compared with non-PTx patients. No difference was observed between the groups in the risk for kidney stone formation or the QoL indices (physical and social function, physical and emotional role function, mental health, vitality and bodily pain; general health higher in the non-PTx group).

Conclusions: PTx is not a first-line treatment option in patients with mild PHPT, as it does not improve fracture, nephrolithiasis risk or QoL, compared with conservative management; however, PTx does improve BMD and serum calcium concentrations.