Primary Hyperparathyroidism: Assessment of the Effects of Parathyroidectomy Using Dual X-Ray Absorptiometry, Trabecular Bone Score, and Dual X-Ray Absorptiometry-Based Three-Dimensional Modeling

Objective: This study aimed to evaluate the bone microstructure to determine whether curative surgery of primary hyperparathyroidism produces changes in bone mineral density (BMD), trabecular bone score (TBS), and three-dimensional (3D) dual x-ray absorptiometry (DXA) parameters and whether these changes are comparable. Methods: We retrospectively studied 85 patients (60 women and 25 men, 60.4 +/- 12.5 years) diagnosed with primary hyperparathyroidism and undergoing parathyroidectomy. Mean percent changes in BMD (lumbar spine [LS], femoral neck [FN], total hip [TH], and 1/3 radius), TBS and 3D-DXA parameters (trabecular volumetric BMD (vBMD), cortical vBMD, integral vBMD, cortical surface density (sBMD), and cortical thickness at TH) after surgery (12, 24, and/or 36 months) were calculated and compared, and we sought the determinants of these changes. Results: After parathyroidectomy, BMD presented statistically signi ficant mean increases in LS, FN, and TH during the first 3 years after surgery ( P < .001), accompanied by an improvement in all 3D-DXA parameters, but there were no signi ficant changes in 1/3 radius BMD or TBS. Cortical sBMD, trabecular vBMD, and integral vBMD reached mean increases of similar magnitude to those of FN and TH BMD. Age and preoperative serum levels of parathyroid hormone and carboxy -terminal telopeptide of type 1 collagen were signi ficantly associated with percent changes after surgery. Conclusion: We found a bene fit of parathyroidectomy for bone, with signi ficant percent increases in LS, FN, and TH BMD up to the third year after surgery, and a qualitative bene fit for the hip in both its trabecular and cortical compartments and bone strength. (c) 2024 AACE. Published by Elsevier Inc. All rights reserved.