title: Calcimimetics versus parathyroidectomy for treatment of primary hyperparathyroidism: retrospective chart analysis of a prospective database.
abstract: OBJECTIVE
  This study aims to determine the efficacy of calcimimetics in improving bone mineral density (BMD) in patients with primary hyperparathyroidism (pHPT) and compare those results to patients undergoing parathyroidectomy.
  
  
  BACKGROUND
  Parathyroidectomy has been shown to improve BMD in pHPT, but calcimimetics have recently been advocated as a medical alternative to parathyroidectomy for pHPT.
  
  
  METHODS
  We identified 17 patients that were treated with calcimimetics for pHPT. Seventeen patients with pHPT who underwent parathyroidectomy served as surgical controls. Serum calcium level, parathyroid hormone (PTH) level, and femur and spine BMD T scores were compared before and 1 year after therapy.
  
  
  RESULTS
  Both groups were demographically matched. Calcium levels normalized in 70.6% of medically versus 100% of surgically treated patients (P = 0.026). PTH levels normalized in 35% of patients treated with calcimimetics versus 76% of surgical patients (P = 0.036). Femur BMD improved in 18.8% of medically treated patients versus 58.8% of surgical patients (P = 0.032). Spine BMD improved in 70.6% of medically treated patients versus 82.4% of surgical patients (P = 0.69). Further analysis demonstrated that regardless of treatment, normalization of PTH was associated with significant improvement in femur (P = 0.03) and spine BMD (P < 0.001). Normalization of calcium without normalization of PTH did not impact BMD.
  
  
  CONCLUSIONS
  Parathyroidectomy results in greater normalization of serum calcium and PTH levels and significantly improves cortical BMD compared to calcimimetics. Regardless of treatment, normalization of PTH is associated with significant improvement in spine and femur BMD, suggesting that the superior effects of surgery may be mediated by better control of PTH.
authors.affiliation: Department of Surgery, Division of Minimal Invasive and Endocrine Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10068, USA.
authors.forename: Xavier M
authors.initials: XM
authors.lastname: Keutgen
authors.forename: Daniel
authors.initials: D
authors.lastname: Buitrago
authors.forename: Filippo
authors.initials: F
authors.lastname: Filicori
authors.forename: Anna
authors.initials: A
authors.lastname: Kundel
authors.forename: Olivier
authors.initials: O
authors.lastname: Elemento
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000368:Aged; D015519:Bone Density; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D002118:Calcium