Bone health in patients undergoing surgery for primary hyperparathyroidism at Tygerberg Hospital, Cape Town, South Africa

Abstract

Background: Increased bone resorption is a well-described consequence of primary hyperparathyroidism (PHPT). In South Africa, little is known about the impact of PHPT on skeletal health. Objective: To determine the prevalence of decreased bone mineral density (BMD), vertebral fractures and osteitis fibrosa cystica in patients with PHPT who underwent parathyroidectomy. Methods: Retrospective study of patients who underwent parathyroidectomy for PHPT at Tygerberg Hospital in Cape Town, from January 2010 to December 2019. Clinical, biochemical and BMD parameters are described. Results: Final analysis included 56 patients (median age 63.5 years; 80.4% female). Initial calcium, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) levels were 2.93 mmol/l, 19.4 pmol/l and 34.0 nmol/l, respectively. Of the total cohort, 71.4% had decreased BMD. The prevalence of osteoporosis and osteopenia in postmenopausal women and men ≥ 50 years was 50.0% and 39.1% respectively; low bone mass for age in premenopausal women and men < 50 years was 20.0%. Vertebral fractures were seen in 21.2% of patients on radiography. Osteitis fibrosa cystica was present in five patients (9.6%). PTH levels were significantly elevated in patients with osteoporosis compared with those with normal BMD (36.4 vs. 16.1 pmol/l; p = 0.02). Conclusion: Two-thirds of patients who underwent parathyroidectomy for PHPT had decreased BMD, with osteoporosis present in 50% of postmenopausal women and older men. One in five had vertebral fractures. These findings underscore the importance of skeletal assessment in the management of PHPT.

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

“…There is a paucity of data on patients with PHPT from Africa, and only two previous reports from South Africa [ 10 , 11 ]. In a study from our centre (Inkosi Albert Luthuli Central Hospital (IALCH)) in Durban, the characteristics and outcome of PHPT were analysed in 28 patients over 6 years (2003–2009).…”

“…The majority (92.9%) of patients had symptomatic disease and surgery was successful in 94.7% of patients [ 10 ]. A more recent report from Cape Town also reviewed BMD findings, rates of vertebral fractures and osteitis fibrosa cystica in patients with PHPT who had parathyroidectomy; 50% of post-menopausal women and older men had osteoporosis and 21% of patients had vertebral fractures [ 11 ]. The limited information highlights the need for further reports from South Africa and sub-Saharan Africa (SSA) regarding the frequency of asymptomatic disease presentation, vitamin D status of patients with PHPT and the utility of intra-operative PTH (IO-PTH) monitoring.…”

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

“…IO-PTH has been shown to be highly sensitive and speci c in predicting operative success. (9) There is a paucity of data on patients with PHPT from Africa, and only two previous reports from South Africa (10,11). In a study from our centre (Inkosi Albert Luthuli Central Hospital (IALCH)) in Durban, the characteristics and outcome of PHPT were analysed in 28 patients over 6 years (2003 -2009).…”

“…The majority (92.9%) of patients had symptomatic disease and surgery was successful in 94.7% of patients (10). A more recent report from Cape Town also reviewed BMD ndings, rates of vertebral fractures and osteitis brosa cystica in patients with PHPT who had parathyroidectomy; 50% of postmenopausal women and older men had osteoporosis and 21% of patients had vertebral fractures (11). The limited information highlights the need for further reports from South Africa and sub-Saharan Africa (SSA) regarding the frequency of asymptomatic disease presentation, vitamin D status of patients with PHPT and the utility of intra-operative PTH (IO-PTH) monitoring.…”