title: Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism.
abstract: OBJECTIVE
  To study whether fracture risk before and after surgery was increased in patients with primary hyperparathyroidism.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Three Danish university hospitals.
  
  
  METHODS
  674 consecutive patients with primary hyperparathyroidism (median age 61, range 13-89 years) operated on during the period 1 January 1979 to 31 December 1997; 2021 age and sex matched controls from national patient register.
  
  
  METHODS
  Fractures.
  
  
  RESULTS
  The cases had an increased relative rate of fractures compared with the controls before surgery (1.8, 95% confidence interval 1.3 to 2.3) but not after surgery (1.0, 0.8 to 1.3). The risk of fracture was increased for the vertebrae (3.5, 1.3 to 9.7), the distal part of the lower leg and ankles (2.3, 1.2 to 4.3), and the non-distal part of the forearm (4.0, 1.5 to 10.6) before surgery but not after. The increase in risk of fracture began about 10 years before surgery. Risk peaked 5-6 years before surgery and remained raised, although at a lower level, in the five years immediately before surgery. A small increase in risk of fracture of the distal forearm emerged more than 10 years after surgery (2.9, 1. 3 to 6.7).
  
  
  CONCLUSIONS
  Risk of fracture is increased up to 10 years before surgery in patients with primary hyperparathyroidism. The risk returns to normal after surgery.
authors.affiliation: Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus Amtssygehus, Aarhus, Denmark. p-vest@post4.tele.dk
authors.forename: P
authors.initials: P
authors.lastname: Vestergaard
authors.forename: C L
authors.initials: CL
authors.lastname: Mollerup
authors.forename: V G
authors.initials: VG
authors.lastname: Frøkjaer
authors.forename: P
authors.initials: P
authors.lastname: Christiansen
authors.forename: M
authors.initials: M
authors.lastname: Blichert-Toft
authors.forename: L
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000209:etiology / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology; D012306:Risk; D013997:Time Factors