Analysis of Comorbidities, Clinical Outcomes, and Parathyroidectomy in Adults With Primary Hyperparathyroidism

被引:27
作者
Axelsson, Kristian F. [1 ,2 ]
Wallander, Marit [2 ]
Johansson, Helena [2 ,3 ]
Harvey, Nicholas C. [4 ,5 ]
Vandenput, Liesbeth [2 ,3 ]
McCloskey, Eugene [6 ,7 ]
Liu, Enwu [3 ]
Kanis, John A. [3 ,7 ]
Litsne, Henrik [2 ]
Lorentzon, Mattias [2 ,3 ,8 ]
机构
[1] Narhalsan Norrmalm, Hlth Ctr, Reg Vastra Gotaland, Skovde, Sweden
[2] Univ Gothenburg, Sahlgrenska Osteoporosis Ctr, Inst Med, Dept Internal Med & Clin Nutr, Gothenburg, Sweden
[3] Australian Catholic Univ, Mary MacKillop Inst Hlth Res, Melbourne, Vic, Australia
[4] Univ Southampton, Med Res Council MRC Lifecourse Epidemiol Ctr, Southampton, Hants, England
[5] Univ Southampton, Natl Inst Hlth Res, Southampton Biomed Res Ctr, Southampton, Hants, England
[6] Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England
[7] Univ Sheffield, MRC Versus Arthrit Ctr Integrated Res Musculoskel, Mellanby Ctr Musculoskeletal Res, Sheffield, S Yorkshire, England
[8] Sahlgrens Univ Hosp, Dept Geriatr Med, Reg Vastra Gotaland, Molndal, Sweden
基金
瑞典研究理事会;
关键词
FOLLOW-UP; CARDIOVASCULAR-DISEASE; SURGERY; RISK; MORTALITY; FRACTURE; COHORT; EPIDEMIOLOGY; MORBIDITY; HORMONE;
D O I
10.1001/jamanetworkopen.2022.15396
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results from previous studies have been inconsistent. Evidence of the association of parathyroidectomy (PTX) with these outcomes is also limited because of the lack of large well-controlled trials. OBJECTIVE To investigate whether untreated pHPT was associated with an increased risk of incident fractures and cardiovascular events (CVEs) and whether PTX was associated with a reduced risk of these outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all patients who were diagnosed with pHPT at hospitals in Sweden between July 1, 2006, and December 31, 2017. Each patient was matched with 10 control individuals from the general population by sex, birth year, and county of residence. The patients were followed up until December 31, 2017. Data analyses were performed from October 2021 to April 2022. MAIN OUTCOMES AND MEASURES The primary outcomes were fractures, CVEs, and death. Cumulative incidence of events was estimated using the 1-minus Kaplan-Meier estimator of corresponding survival function. Cox proportional hazards regression models were used to calculate hazard ratios (HRs). RESULTS A total of 16 374 patients with pHPT were identified (mean [SD] age, 67.5 [12.9] years; 12 806 women [78.2%]), with 163 740 control individuals. The follow-up time was 42 310 person-years for the pH PT group and 803 522 person-years for the control group. Compared with the control group, the pH PT group had a higher risk of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), CVEs (unadjusted HR, 1.45; 95% CI, 1.34-1.57), and death (unadjusted HR, 1.72; 95% CI, 1.65-1.80). In a time-dependent Poisson regression model, PTX was associated with a reduced risk of any fracture (HR, 0.83; 95% CI, 0.75-0.93), hip fracture (HR, 0.78; 95% CI, 0.61-0.98), CVEs (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65). CONCLUSIONS AND RELEVANCE Results of this study suggest that pHPT is associated with increased risk of fractures, CVEs, and death, highlighting the importance of identifying patients with this condition to prevent serious unfavorable outcomes. The reduced risk of these outcomes associated with PTX suggests a clinical benefit of surgery.
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页数:14
相关论文
共 40 条
[1]   Mortality Is Not Increased in Recombinant Human Growth Hormone-treated Patients When Adjusting for Birth Characteristics [J].
Albertsson-Wikland, Kerstin ;
Martensson, Anton ;
Savendahl, Lars ;
Niklasson, Aimon ;
Bang, Peter ;
Dahlgren, Jovanna ;
Gustafsson, Jan ;
Kristrom, Berit ;
Norgren, Svante ;
Pehrsson, Nils-Gunnar ;
Oden, Anders .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2016, 101 (05) :2149-2159
[2]   Kidney stones and kidney function loss: a cohort study [J].
Alexander, R. Todd ;
Hemmelgarn, Brenda R. ;
Wiebe, Natasha ;
Bello, Aminu ;
Morgan, Catherine ;
Samuel, Susan ;
Klarenbach, Scott W. ;
Curhan, Gary C. ;
Tonelli, Marcello .
BMJ-BRITISH MEDICAL JOURNAL, 2012, 345
[3]   Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis of randomized-controlled studies [J].
Anagnostis, P. ;
Vaitsi, K. ;
Veneti, S. ;
Potoupni, V. ;
Kenanidis, E. ;
Tsiridis, E. ;
Papavramidis, T. S. ;
Goulis, D. G. .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 2021, 44 (06) :1127-1137
[4]   End-organ effects of primary hyperparathyroidism: A population-based study [J].
Assadipour, Yasmine ;
Zhou, Hui ;
Kuo, Eric J. ;
Haigh, Philip I. ;
Adams, Annette L. ;
Yeh, Michael W. .
SURGERY, 2019, 165 (01) :99-104
[5]   Effectiveness of a minimal resource fracture liaison service [J].
Axelsson, K. F. ;
Jacobsson, R. ;
Lund, D. ;
Lorentzon, M. .
OSTEOPOROSIS INTERNATIONAL, 2016, 27 (11) :3165-3175
[6]   Primary Hyperparathyroidism [J].
Bilezikian, John P. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2018, 103 (11) :3993-4004
[7]   Effect of Surgery on Cardiovascular Risk Factors in Mild Primary Hyperparathyroidism [J].
Bollerslev, Jens ;
Rosen, Thord ;
Mollerup, Charlotte L. ;
Nordenstroem, Joergen ;
Baranowski, Marek ;
Franco, Celina ;
Pernow, Ylva ;
Isaksen, Gunhild A. ;
Godang, Kristin ;
Ueland, Thor ;
Jansson, Svante .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (07) :2255-2261
[8]  
Breslow N E, 1987, IARC Sci Publ, P1
[9]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[10]   Epidemiology and outcomes of osteoporotic fractures [J].
Cummings, SR ;
Melton, LJ .
LANCET, 2002, 359 (9319) :1761-1767