title: Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism.
abstract: BACKGROUND
  Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed.
  
  
  OBJECTIVE
  To study the effect of parathyroidectomy (PTX) compared with observation (OBS) on biochemistry, safety, bone mineral density (BMD), and new fractures.
  
  
  METHODS
  Prospective, randomized controlled study (SIPH study), with a 5-year follow-up.
  
  
  METHODS
  The study was conducted at multicenter, tertiary referral centers.
  
  
  METHODS
  Of 191 randomized patients with mild PHPT, biochemical data were available for 145 patients after 5 years, with a mean age at inclusion of 62.8 years (OBS group, 9 males) and 62.1 years (PTX group, 10 males).
  
  
  METHODS
  Parathyroidectomy vs observation.
  
  
  METHODS
  Biochemistry, BMD, and new radiographic vertebral fractures.
  
  
  RESULTS
  Serum-calcium and PTH-levels normalized after surgery and did not deteriorate by observation. BMD Z-scores were normal at inclusion in the lumbar spine (LS) and femoral neck (FN). For LS, BMD Z-scores were stable for 5 years with observation, but decreased in FN (P < .02). After surgery, BMD Z-scores increased significantly in both compartments (P < .02 for both), with a highly significant treatment effect of surgery compared to observation (P < .001). During follow-up, five new clinically unrecognized vertebral fractures were found in 5 females, all in the OBS group (P = .058).
  
  
  CONCLUSIONS
  Even though new vertebral fractures occurred only in the observation group, the frequency was not significantly different from the surgery group. Longer follow-up is needed before firm conclusions can be drawn about the long-term safety of observation, as opposed to surgery.
authors: Department of Radiology (K.L., M.H.), Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden; Section of Specialized Endocrinology (A.H., K.G., J.B.), Oslo University Hospital, and Faculty of Medicine, University of Oslo, 0372 Oslo, Norway; Clinic of Breast and Endocrine Surgery (C.M.), Center HOC, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; St. Olavs Hospital (M.B.), 7030 Trondheim, Norway; Departments of Molecular Medicine and Surgery, and Endocrinology (Y.P.), Karolinska Institutet, Karolinska University Hospital, 171 77 Stockholm, Sweden; Department of Surgery (J.E.V.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Surgical Sciences (O.H.), University of Uppsala, 751 85 Uppsala, Sweden; Department of Medicine (T.R.), Section of Endocrinology, Diabetes and Metabolism, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden; Department of Molecular Medicine and Surgery (J.N.), Karolinska Institutet, 171 76 Stockholm, Sweden; Department of Surgery (S.J.), Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
authors: Karolina
authors: K
authors: Lundstam
authors: Ansgar
authors: A
authors: Heck
authors: Charlotte
authors: C
authors: Mollerup
authors: Kristin
authors: K
authors: Godang
authors: Marek
authors: M
authors: Baranowski
authors: Ylva
authors: Y
authors: Pernow
authors: Jan Erik
authors: JE
authors: Varhaug
authors: Ola
authors: O
authors: Hessman
authors: Thord
authors: T
authors: Rosén
authors: Jörgen
authors: J
authors: Nordenström
authors: Svante
authors: S
authors: Jansson
authors: Mikael
authors: M
authors: Hellström
authors: Jens
authors: J
authors: Bollerslev
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019370:Observation; D016105:Parathyroidectomy / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D014545:Urinary Calculi / Q000000981:diagnostic imaging / Q000453:epidemiology; D014567:Urography; D057832:Watchful Waiting / Q000706:statistics & numerical data