title: Fracture risk after parathyroidectomy among chronic hemodialysis patients.
abstract: The impact of parathyroidectomy (PTX) on the long-term risks for hip and other fractures is unknown. Uncontrolled case series have reported an increase in bone mineral density after PTX. However, very low serum parathyroid hormone levels have been associated with decreased bone mineral density, adynamic bone disease, and fractures. This study compared long-term fracture rates among hemodialysis patients who underwent PTX with a matched control group. Data were obtained from the US Renal Data System. Patients who underwent a first PTX while receiving hemodialysis were matched with up to three control patients by age, race, gender, year of dialysis initiation, primary cause of renal failure, and the dosage of intravenous vitamin D used before PTX. Patients with a history of fracture or renal transplantation were excluded. Study outcomes were incident hip, vertebral, and distal radius-wrist fractures identified using hospitalization codes. Incident hip fracture rates in the PTX and matched control groups were 6.0 and 9.3 fractures per 1000 person-years, respectively. After adjustment, PTX was associated with a significant 32% lower risk for hip fracture (95% confidence interval 0.54 to 0.86; P = 0.001) and a 31% lower risk for any analyzed fracture (95% confidence interval 0.57 to 0.83; P < 0.001) compared with matched control subjects. Fracture risks were lower among hemodialysis patients who underwent PTX compared with matched control subjects. Surgical amelioration of secondary hyperparathyroidism may outweigh the risk of parathyroid hormone oversuppression in terms of bone health.
authors.affiliation: Division of Biostatistics, Harborview Medical Center, University of Washington, Seattle, WA 98104-2499, USA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Rudser
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: Annemarie
authors.initials: A
authors.lastname: Dooley
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology* / Q000601:surgery; D015994:Incidence; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D011885:Radius Fractures / Q000453:epidemiology; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D