Bone Abstracts

Background: Primary Hyperparathyroidism (PHPT) is an important endocrine cause of secondary osteoporosis, characterized by increased bone resorption and reduced bone mineral density. Early identification and appropriate treatment are essential to prevent fractures and long-term skeletal complications. Management options include pharmacological therapies such as antiresorptive agents and definitive surgical intervention. This audit evaluated the current treatment approaches used in patients with hyperparathyroidism-related osteoporosis in a single UK teaching hospital practice.

Methods: We performed a retrospective audit of patients with primary hyperparathyroidism identified over a 12-month period from January to December 2025 under the care of the bone and calcium service in our centre. All new and follow up patients with a confirmed diagnosis of PHPT were included. Patients were included if they had primary hyperparathyroidism and a T-score of -2.5 or below at at least one skeletal site. For each patient, the most severe available T-score (lowest value) from the femoral neck, lumbar spine, or total hip was used for analysis. Demographic data, bone density, antiresorptive medication treatment, and surgical status were collected and analysed.

Results: A total of 95 patients with primary hyperparathyroidism were screened, of whom 32 met inclusion criteria. The cohort was predominantly female (31/32, 96.9%) with a mean age of 74.9 years. The mean most severe T-score was -3.3 (median -3.2, range -4.9 to -2.5), demonstrating a substantial burden of osteoporosis. 22/32 (68.8%) patients received either oral or intravenous bisphosphonate therapy and 3/32 (9.4%) received denosumab. Overall, 25/32 (78.1%) received antiresorptive treatment. Parathyroid surgery had already taken place in 6/32 (18.8%) patients. A further 10/32 (31.3%) were awaiting surgery, 2/32 (6.25%) had declined surgery, and 14/32 (43.8%) had no surgery planned at the time of review.

Conclusion: This audit demonstrates that patients with primary hyperparathyroidism and osteoporosis within our service have markedly reduced bone mineral density and are managed predominantly with antiresorptive therapy, while only a minority had undergone definitive surgical treatment at the time of assessment. These findings highlight a significant skeletal disease burden and emphasise the need for timely review of surgical eligibility alongside optimisation of bone-protective management.