The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism.
Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of parathyroidectomy.



In a cohort of 20,056 patients on dialysis or with functioning renal allograft, we identified 590 patients who underwent parathyroidectomy between 1991 and 2009. Of these, 579 were matched with 1970 non-PTX patients on age, sex, cause of renal disease and functioning renal allograft or not at the time of PTX or at the corresponding time for non-PTX patients (t). We calculated the risk for hip fracture after PTX using crude and adjusted Cox proportional hazards regressions, adjusting for time in renal replacement therapy before t, time with functioning renal allograft before and after t, comorbidity at t and a hip fracture before t.



The adjusted hazard ratio (95% confidence interval) for hip fracture was 0.40 (0.18-0.88) for PTX patients, compared to non-PTX patients. When analyses were performed separately for sex, only women had a lower risk of hip fracture after PTX compared to non-PTX patients. The risk of hip fracture after PTX was similar in patients with or without functioning renal allograft at time for PTX.



Parathyroidectomy is associated with a lower risk of hip fracture in female patients with secondary hyperparathyroidism.
Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. elin.isaksson@med.lu.se.|Department of Urology, Lund University, Skåne University Hospital, Malmö, Sweden. elin.isaksson@med.lu.se.
Elin
E
Isaksson
Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.|Department of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Kerstin
K
Ivarsson
Department of Nephrology, Lund University, Skåne University Hospital, Lund, Sweden.|Department of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Shahriar
S
Akaberi
Endocrine and Sarcoma Surgery, Department of Surgery, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Andreas
A
Muth
Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.|Department of Nephrology, Lund University, Skåne University Hospital, Malmö, Sweden.
Gunnar
G
Sterner
Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.
Prütz
P
Karl-Göran
Department of Nephrology, Lund University, Skåne University Hospital, Lund, Sweden.|Department of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Naomi
N
Clyne
Department of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.|Department of Surgery Section of Endocrine and Sarcoma, Lund University, Skåne University Hospital, Lund, Sweden.
Martin
M
Almquist
D000328:Adult; D000368:Aged; D064591:Allografts / Q000502:physiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors