Download PDF
Horm Metab Res 2018; 50(03): 242-249
DOI: 10.1055/s-0043-125334
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Long-Term Skeletal Outcomes of Primary Hyperparathyroidism Patients After Treatment with Parathyroidectomy: A Systematic Review and Meta-Analysis

Lu Zhang
1   Department of Orthopedics, Yangling Demonstration Zone Hospital, Xianyang, Shaanxi, P. R. China
,
Xiaomei Liu
2   Department of Nursing, Yanan University Affiliated Hospital, Yanan Shaanxi, P. R. China
,
Hongwei Li
3   Department of Orthopedics, Yulin No. 2 Hospital, Yulin, Shaanxi, P. R. China
› Author Affiliations
Further Information

Publication History

received 11 July 2017

accepted 20 December 2017

Publication Date:
30 January 2018 (online)

Also available at
    Permissions and Reprints

Abstract

The aim of the study was to assess and define the association between parathyroidectomy (PTX) and long-term skeletal outcomes in primary hyperparathyroidism (PHPT) patients. PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched up to June 31, 2017, without language restriction. Any study comparing skeletal outcomes [fracture risk or bone mineral density (BMD)] of PHPT patients after more than 12 months of PTX treatment versus non-PTX treatment was included. Pooled relative risks or odds ratios with 95% confidence intervals and weighted mean difference were calculated using random-effects models irrespective of statistical heterogeneity assessed by I2 statistic. Finally, 5 randomized controlled trials (RCTs, n=584) and 10 cohort studies (CSs, n=12202) were included. CSs suggest PTX treatment versus non-PTX treatment is significantly associated with 36% reduction in the risk of fracture, with no heterogeneity, and an increase in the lumbar spine change by 0.55 WMD, with no heterogeneity. RCTs indicate PTX treatment versus non-PTX treatment is significantly associated with BMD change of 0.97 WMD at the lumbar spine with substantial heterogeneity, and 1.23 WMD at the femoral neck with no heterogeneity. The existing CSs indicate PTX-treatment versus non-PTX-treatment might reduce the risk of fracture in PHPT patients. The existing RCTs do not provide sufficient or precise evidence that PTX-treatment affects the fracture risk of PHPT patients, but offer data that subsets of patients who could potentially benefit from PTX-treatment can be identified.

Key words

primary hyperparathyroidism - parathyroidectomy - outcomes

Supplementary Material

 

  • References

  • 1 Gasparri G. Updates in primary hyperparathyroidism. Updates Surg 2017; 69: 217-223
    CrossrefPubMedGoogle Scholar
  • 2 Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, Haigh PI, Adams AL. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 2013; 98: 1122-1129
    CrossrefPubMedGoogle Scholar
  • 3 Collier A, Portelli M, Ghosh S, Nowell S, Clark D. Primary hyperparathyroidism: Increasing prevalence, social deprivation, and surgery. Endocr Res 2017; 42: 31-35
    CrossrefPubMedGoogle Scholar
  • 4 Chen HH, Chen YW, Wu CJ. Primary hyperparathyroidism in Taiwan: clinical features and prevalence in a single-center experience. Endocrine 2010; 37: 373-378
    CrossrefPubMedGoogle Scholar
  • 5 Hari Kumar KVS, Patnaik SK. Incidence of parathyroid disorders in an indian adult male population: A 25 year follow up study. Clin Endocrinol (Oxf) 2017; 87: 605-608
    CrossrefPubMedGoogle Scholar
  • 6 Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, Thakker R, D'Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: Review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017; 28: 1-19
    PubMedGoogle Scholar
  • 7 Siilin H, Rastad J, Ljunggren O, Lundgren E. Disturbances of calcium homeostasis consistent with mild primary hyperparathyroidism in premenopausal women and associated morbidity. J Clin Endocrinol Metab 2008; 93: 47-53
    CrossrefPubMedGoogle Scholar
  • 8 Syed H, Khan A. Primary hyperparathyroidism: diagnosis and management in 2017. Pol Arch Intern Med 2017; 127: 438-441
    PubMedGoogle Scholar
  • 9 Cipriani C, Biamonte F, Costa AG, Zhang C, Biondi P, Diacinti D, Pepe J, Piemonte S, Scillitani A, Minisola S, Bilezikian JP. Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J Clin Endocrinol Metab 2015; 100: 1309-1315
    CrossrefPubMedGoogle Scholar
  • 10 Eller-Vainicher C, Battista C, Guarnieri V, Muscarella S, Palmieri S, Salcuni AS, Guglielmi G, Corbetta S, Minisola S, Spada A, Hendy GN, Cole DE, Chiodini I, Scillitani A. Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism. Eur J Endocrinol 2014; 171: 399-406
    CrossrefPubMedGoogle Scholar
  • 11 Almqvist EG, Becker C, Bondeson AG, Bondeson L, Svensson J. Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism: A prospective and randomized study. Surgery 2004; 136: 1281-1288
    CrossrefPubMedGoogle Scholar
  • 12 Nilsson IL, Norenstedt S, Zedenius J, Pernow Y, Bränström R. Primary hyperparathyroidism, hypercalciuria, and bone recovery after parathyroidectomy. Surgery 2017; 162: 429-436
    CrossrefPubMedGoogle Scholar
  • 13 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008; 93: 3462-3470
    CrossrefPubMedGoogle Scholar
  • 14 Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341: 1249-1255
    CrossrefPubMedGoogle Scholar
  • 15 Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99: 3561-3569
    CrossrefPubMedGoogle Scholar
  • 16 Kim SM, Shu AD, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Declining rates of inpatient parathyroidectomy for primary hyperparathyroidism in the US. PLoS One 2016; 11: e0161192
    CrossrefPubMedGoogle Scholar
  • 17 Francucci CM, Ceccoli L, Caudarella R, Rilli S, Vescini F, Boscaro M. Asymptomatic primary hyperparathyroidism: Surgical and medical management. J Endocrinol Invest 2011; 34: 50-54
    PubMedGoogle Scholar
  • 18 Niederle B, Wémeau JL. Is surgery necessary for 'mild' or 'asymptomatic' hyperparathyroidism. Eur J Endocrinol 2015; 173: D13-D20
    CrossrefPubMedGoogle Scholar
  • 19 Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The relationship of parathyroidectomy and bisphosphonates with fracture risk in primary hyperparathyroidism: An observational study. Ann Intern Med 2016; 164: 715-723
    CrossrefPubMedGoogle Scholar
  • 20 Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, Varhaug JE, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J. Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2015; 100: 1359-1367
    CrossrefPubMedGoogle Scholar
  • 21 Rao DS, Wallace EA, Antonelli RF, Talpos GB, Ansari MR, Jacobsen G, Divine GW, Parfitt AM. Forearm bone density in primary hyperparathyroidism: Long-term follow-up with and without parathyroidectomy. Clin Endocrinol (Oxf) 2003; 58: 348-354
    CrossrefPubMedGoogle Scholar
  • 22 Tournis S, Fakidari E, Dontas I, Liakou C, Antoniou J, Galanos A, Marketou H, Makris K, Katsalira K, Trovas G, Lyritis GP, Papaioannou N. Effect of parathyroidectomy versus risedronate on volumetric bone mineral density and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism. J Bone Miner Metab 2014; 32: 151-158
    CrossrefPubMedGoogle Scholar
  • 23 Singh ON, Maraka S, Rodriguez-Gutierrez R, de Ycaza AEE, Jasim S, Gionfriddo M, Castaneda-Guarderas A, Brito JP, Al NA, Erwin P, Wermers R, Montori V. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: A systematic review and meta-analysis. Osteoporos Int 2016; 27: 3395-3407
    CrossrefPubMedGoogle Scholar
  • 24 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar
  • 25 Gao Y, Zhang K, Xi H, Cai A, Wu X, Cui J, Li J, Qiao Z, Wei B, Chen L. Diagnostic and prognostic value of circulating tumor DNA in gastric cancer: a meta-analysis. Oncotarget 2017; 8: 6330-6340
    CrossrefPubMedGoogle Scholar
  • 26 Wu XL, Tu Q, Faure G, Gallet P, Kohler C, Bittencourt MC. Diagnostic and prognostic value of circulating tumor cells in head and neck squamous cell carcinoma: A systematic review and meta-analysis. Sci Rep 2016; 6: 20210
    CrossrefPubMedGoogle Scholar
  • 27 Berkman ND, Lohr KN, Ansari MT, Balk EM, Kane R, McDonagh M, Morton SC, Viswanathan M, Bass EB, Butler M, Gartlehner G, Hartling L, McPheeters M, Morgan LC, Reston J, Sista P, Whitlock E, Chang S. Grading the strength of a body of evidence when assessing health care interventions: An EPC update. J Clin Epidemiol 2015; 68: 1312-1324
    CrossrefPubMedGoogle Scholar
  • 28 Han S, Wan S, Ning L, Tong Y, Zhang J, Fan S. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: A meta-analysis of randomised and non-randomised controlled trials. Int Orthop 2011; 35: 1349-1358
    CrossrefPubMedGoogle Scholar
  • 29 Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463
    CrossrefPubMedGoogle Scholar
  • 30 Lundstam K, Heck A, Godang K, Mollerup C, Baranowski M, Pernow Y, Aas T, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J. SIPH Study Group. Effect of surgery vs observation: Skeletal 5-year outcomes in a randomized trial of patients with primary HPT (the SIPH study). J Bone Miner Res 2017; 32: 1907-1914
    CrossrefPubMedGoogle Scholar
  • 31 Keutgen XM, Buitrago D, Filicori F, Kundel A, Elemento O, Fahey TJ, Zarnegar R. Calcimimetics versus parathyroidectomy for treatment of primary hyperparathyroidism: retrospective chart analysis of a prospective database. Ann Surg 2012; 255: 981-985
    CrossrefPubMedGoogle Scholar
  • 32 Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: A prospective, randomized clinical trial. J Clin Endocrinol Metab 2007; 92: 3114-3121
    CrossrefPubMedGoogle Scholar
  • 33 Bollerslev J, Jansson S, Mollerup CL, Nordenström J, Lundgren E, Tørring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: A prospective, randomized trial. J Clin Endocrinol Metab 2007; 92: 1687-1692
    CrossrefPubMedGoogle Scholar
  • 34 Rao DS, Phillips ER, Divine GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 2004; 89: 5415-5422
    CrossrefPubMedGoogle Scholar
  • 35 Mak SL, Leung KY. Hepatitis B carriers in Hong Kong: prevalence and pregnancy outcomes. Hong Kong J Gynaecol Obstet Midwifery 2013; 13: 67-73
    PubMedGoogle Scholar
  • 36 Tournis S, Fakidari E, Dontas I, Liakou C, Antoniou J, Galanos A, Marketou H, Makris K, Katsalira K, Trovas G, Lyritis GP, Papaioannou N. Effect of parathyroidectomy versus risedronate on volumetric bone mineral density and bone geometry at the tibia in postmenopausal women with primary hyperparathyroidism. J Bone Miner Metab 2014; 32: 151-158
    CrossrefPubMedGoogle Scholar
  • 37 Nomura R, Sugimoto T, Tsukamoto T, Yamauchi M, Sowa H, Chen Q, Yamaguchi T, Kobayashi A, Chihara K. Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; A six-year longitudinal study with or without parathyroidectomy in a Japanese population. Clin Endocrinol (Oxf) 2004; 60: 335-342
    CrossrefPubMedGoogle Scholar
  • 38 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008; 93: 3462-3470
    CrossrefPubMedGoogle Scholar
  • 39 Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341: 1249-1255
    CrossrefPubMedGoogle Scholar
  • 40 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg 2009; 33: 406-411
    CrossrefPubMedGoogle Scholar
  • 41 VanderWalde LH, Liu IL, O'Connell TX, Haigh PI. The effect of parathyroidectomy on bone fracture risk in patients with primary hyperparathyroidism. Arch Surg 2006; 141: 885-889
    CrossrefPubMedGoogle Scholar
  • 42 Vestergaard P, Mosekilde L. Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. Br Med J (Clin Res Ed) 2003; 327: 530-533
    CrossrefPubMedGoogle Scholar
  • 43 Fang WL, Tseng LM, Chen JY, Chiou SY, Chou YH, Wu CW, Lee CH. The management of high-risk patients with primary hyperparathyroidism – minimally invasive parathyroidectomy vs. medical treatment. Clin Endocrinol (Oxf) 2008; 68: 520-528
    CrossrefPubMedGoogle Scholar
  • 44 Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312: 1254-1259
    CrossrefPubMedGoogle Scholar
  • 45 Singh ONM, Rodriguez-Gutierrez R, Maraka S, de Ycaza AEE, Jasim S, Castaneda-Guarderas A, Gionfriddo MR, Al NA, Brito JP, Erwin P, Richards M, Wermers R, Montori VM. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: A systematic review and meta-analysis. World J Surg 2016; 40: 2359-2377
    CrossrefPubMedGoogle Scholar