Fracture Risk Is Lower with Parathyroidectomy Than with Nonoperative Management

Primary hyperparathyroidism (PHPT), which primarily affects people older than 65, is associated with osteoporosis and excess risk for fracture. Parathyroidectomy is the only definitive treatment for PHPT, but most patients with PHPT are managed nonoperatively. In this population-based, longitudinal cohort study, researchers compared fracture risk in 210,000 Medicare beneficiaries (mean age, 75; 79% women) with PHPT who received parathyroidectomy or nonoperative management.

Within 1 year of PHPT diagnosis, 30% of patients underwent parathyroidectomy, and the remainder were managed nonoperatively. Unadjusted fracture rates were 10.2% in the parathyroidectomy group and 13.7% in the nonoperative group after mean follow-up of ≈5 years. Adjusted f…