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Effect of surgery vs observation: skeletal 5-year outcomes in a randomized trial of patients with primary HPT (the SIPH study).

Journal article
Authors Karolina Lundstam
Ansgar Heck
Kristin Godang
Charlotte Mollerup
Marek Baranowski
Ylva Pernow
Turid Aas
Ola Hessman
Thord Rosén
Jörgen Nordenström
Svante Jansson
Mikael Hellström
Jens Bollerslev
Published in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Volume 32
Issue 9
Pages 1907-1914
ISSN 1523-4681
Publication year 2017
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Radiology
Pages 1907-1914
Language en
Subject categories Radiology


Mild primary hyperparathyroidism (PHPT) is known to affect the skeleton, even though patients usually are asymptomatic. Treatment strategies have been widely discussed. However, long-term randomized studies comparing parathyroidectomy to observation are lacking. The objective was to study the effect of parathyroidectomy (PTX) compared to observation (OBS) on bone mineral density (BMD) in g/cm(2) and T-scores, and on biochemical markers of bone turnover (P1NP and CTX-1), in a prospective randomized controlled study of patients with mild PHPT after 5 years of follow-up. Of 191 patients with mild PHPT randomized to either PTX or OBS, 145 patients remained for analysis after 5 years (110 with validated DXA-scans). A significant decrease in P1NP (P < 0.001) and CTX-1 (P < 0.001) was seen in the PTX group, only. A significant positive treatment effect of surgery compared to observation on BMD [g/cm(2) ], was seen for the lumbar spine (LS) (P = 0.011), the femoral neck (FN) (P < 0.001), the ultradistal radius (UDR) (P = 0.042) and for the total body (TB) (P < 0.001), but not for the radius 33% (Rad33) where BMD decreased significantly also in the PTX group (P = 0.012). However, compared to baseline values there was no significant BMD increase in the PTX group, except for the lumbar spine. In the OBS group, there was a significant decrease in BMD [g/cm(2) ] for all compartments (FN P < 0.001; Rad33 P = 0.001; UDR P = 0.006; TB P < 0.001) with the exception of the LS where BMD was stable. In conclusion, parathyroidectomy improves BMD and observation leads to a small, but statistically significant decrease in BMD after 5 years. Thus, bone health appears to be a clinical concern with long-term observation in patients with mild PHPT. This article is protected by copyright. All rights reserved.

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