Skeletal Effects of Interventions in Mild Primary Hyperparathyroidism: A Meta-Analysis

Context: Uncertainty exists as to the optimal management and monitoring of the skeletal consequences of mild primary hyperparathyroidism (PHPT). Objective: The aim of this study was to determine the effects of surgical treatment, medical treatment and no treatment on bone mineral density (BMD) in mild PHPT. Data Sources: Our sources were Medline, EMBASE, and Cochrane CENTRAL prior to January 2009, and abstracts from meetings of international bone and mineral societies from 1987-2008. Study Selection: Eligible studies were of at least 1-yr duration and included more than 10 participants with mild PHPT (serum calcium < 12 mg/dl) who had BMD measured by dual-energy x-ray absorptiometry while being observed without intervention, or treated with antiresorptive therapy or surgery. Primary analysis was of studies of up to 2-yr duration. Secondary analysis was of studies with follow-up beyond 2 yr. Data Extraction: Data were extracted from the text of the retrieved articles or conference abstracts. Data Synthesis: Increases in BMD in response to surgical intervention were comparable to those induced by antiresorptive therapies. Significant bone loss was observed in untreated subjects, but the rates of loss ranged from 0.6-1.0%/yr. Analysis of studies reporting data beyond 2 yr of follow-up demonstrated stable increases in BMD after surgery and stable BMD or slow loss (0.1-0.3%/ yr) in untreated PHPT. Conclusions: Surgical treatment and antiresorptive therapies increase BMD in mild PHPT to a similar degree, and each represents a reasonable option in a patient with mild PHPT and low BMD. Rapid bone loss does not occur in untreated mild PHPT, such that monitoring of BMD less frequently than every 1-2 yr is reasonable in individuals for whom intervention is not immediately required. (J Clin Endocrinol Metab 95: 1653-1662, 2010)