Bone Abstracts

Background: Primary hyperparathyroidism (PHPT) is associated with increased bone turnover, reduced bone mineral density (BMD), and excess fragility fracture risk. Although parathyroidectomy corrects the biochemical disturbance, recovery of skeletal health may be incomplete and postoperative fracture risk may persist. We evaluated long-term fracture outcomes after parathyroidectomy and the extent of postoperative BMD surveillance in routine practice.

Methods: We performed a retrospective single-centre cohort study of adults undergoing parathyroidectomy for PHPT in a UK tertiary centre between 2010 and 2020. Time to first postoperative low-trauma fracture was analysed using KaplanMeier methods and Cox proportional hazards regression. Baseline predictors included age, sex, and preoperative fracture history. Postoperative dual-energy X-ray absorptiometry (DEXA) use, timing, skeletal sites assessed, and BMD categories were described.

Results: The cohort comprised 257 patients, median age 62 years, of whom 71% were female. Over 2,334 person-years of follow-up, 40 patients (16%) sustained at least one postoperative fracture, with median time to first fracture 4.3 years. Estimated fracture-free survival was 91.7% at 5 years, 84.3% at 10 years, and 78.7% at 15 years. In multivariable analysis, increasing age at surgery (HR 1.06 per year, 95% CI 1.031.09; P 0.001) and female sex (HR 4.77, 95% CI 1.4715.50; P 0.009) were independently associated with postoperative fracture. Fracture-free survival was lower in patients with a preoperative fracture history, with KaplanMeier curves separating in an adverse direction over time, although this did not reach statistical significance (HR 1.53, 95% CI 0.743.14; P 0.251). DEXA was performed in only 68/257 patients (26.8%), at a median of 3.7 years after surgery. Among scanned patients, 42.6% had osteopenia and 45.6% osteoporosis at first postoperative DEXA; distal radius assessment was performed in only 27.9%.

Conclusion: Fragility fractures continue to occur for years after parathyroidectomy for PHPT, particularly in older patients and women. Despite this, postoperative bone health surveillance was infrequent and often delayed. These findings support structured follow-up pathways that extend beyond biochemical cure to include timely DEXA reassessment and targeted osteoporosis management.