Radius Bone Mineral Density Measurement Is Essential During Initial PHPT Workup: Results of a Retrospective Study on 400 Patients.

Abstract

Bone mineral density (BMD) measurement at the lumbar spine, femoral neck, total hip, and distal 1/3 radius is recommended for patients with primary hyperparathyroidism (PHPT). Osteoporosis at any site justifies surgery. The distal 1/3 radius is often neglected. This study evaluated the prevalence of distal 1/3 radius measurement, the proportion of osteoporosis at this site alone, and BMD changes 1 year post-parathyroidectomy in patients with PHPT. A total of 548 patients who underwent parathyroidectomy for PHPT between 2016 and 2024 in University Hospital Center of Nantes (France) were reviewed. Patients without pre-surgery BMD measurements at the lumbar spine or the femoral neck were excluded. BMD was assessed via dual x-ray absorptiometry before and 12-months after surgery. Four hundred patients (mean age 63.3 ± 12.3 years, 80.5% female, and 86.2% menopausal) were included. Mean baseline serum calcium was 2.76 ± 0.19 mmol/L; median PTH was 99.2 pg/mL [76.1; 138.7]. Osteoporosis was present in 47.0% of patients. Distal 1/3 radius BMD was measured in 46.2%, identifying 11.4% with forearm-only osteoporosis. They were younger (60.6 ± 13.9 vs. 67.1 ± 10.2 years, p = 0.048), less frequently menopausal (66.7% vs. 95.9%, p = 0.001) and had higher calcium levels (2.88 ± 0.18 vs. 2.73 ± 0.20 mmol/L, p = 0.002) than the other osteoporotic patients. After surgery, BMD increased significantly at the lumbar spine (+0.06 g/cm²) and the total hip (+0.03 g/cm²), in a similar way to other osteoporotic patients. After measuring distal 1/3 radius BMD, performed in < 50% of PHPT patients, it was identified that 11.4% patients had forearm-only osteoporosis, who could have a bone benefit from surgery. These findings emphasize the importance of systematic measurement during PHPT evaluation. NCT05469087.