Summary
Context
Primary hyperparathyroidism reduces bone mineral density, which increases the risk of fracture.
Objective
To investigate differences in bone mineral density and clinical characteristics after parathyroidectomy between men and women (premenopausal and postmenopausal) with sporadic primary hyperparathyroidism.
Design
This is a retrospective study of adult patients who underwent parathyroidectomy in a tertiary referral center from 1990 to 2013.
Patients
A total of 1529 patients underwent parathyroidectomy during the study period; 80 patients met the inclusion criteria. Of these, 24 were men and 56 were women (10 premenopausal and 46 postmenopausal).
Measurements
Demographics, preoperative and postoperative biochemical analysis, preoperative and postoperative T‐scores, preoperative Z‐scores, preoperative and postoperative absolute bone mineral density values, and percentage change in bone mineral density from baseline to 12 ± 6 months after parathyroidectomy in the lumbar spine, femoral neck, total hip and distal one‐third of the nondominant radius.
Results
Preoperative 24‐hour urinary calcium levels were significantly higher in men than in women overall (P = 0.02) and postmenopausal women (P = 0.01). Men had significantly lower preoperative Z‐scores than women overall, premenopausal women and postmenopausal women. Men had greater percentage change of increase in bone mineral density in the femoral neck than did women overall (2.77%; P = 0.04) and postmenopausal women (2.98%; P = 0.03) 1 year after parathyroidectomy.
Conclusions
From this study, men demonstrated a greater improvement of bone mineral density in the femoral neck from baseline after parathyroidectomy compared with women.
A fixed Alb of 4.3 g/dL is acceptable for most clinical evaluations. If Alb is ≤ 3.5 g/dL, along with SHBG ≤ 30 nmol/L, the variance increases and a free testosterone (FT) measurement by equilibrium dialysis is warranted for better accuracy.
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