Bone mineral density outcomes after parathyroidectomy in primary hyperparathyroidism and osteopenia: A meta-analysis and metaregression.

Abstract

Guidelines recommend parathyroidectomy for patients with primary hyperparathyroidism and osteoporosis, although patients with osteopenia often have comparable fracture risk. This systematic review and meta-analysis with metaregression evaluates the effect of parathyroidectomy on bone mineral density in patients with primary hyperparathyroidism and osteopenia. Systematic searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were conducted through November 2024. Eligible studies included randomized controlled trials and cohort studies of adults with primary hyperparathyroidism who underwent parathyroidectomy and had dual X-ray absorptiometry bone mineral density measurements before and after surgery. Studies were required to report the proportion of patients with osteoporosis and/or osteopenia. Outcomes in secondary or tertiary hyperparathyroidism and hereditary syndromes were excluded. Two reviewers independently extracted study-level data. Single-arm random-effects meta-analysis was performed on the mean bone mineral density change after parathyroidectomy at the lumbar spine, femoral neck, total hip, and distal radius. Of 642 unique records screened, 18 studies met inclusion criteria. Pooled analysis demonstrated significant bone mineral density gains at the lumbar spine (+0.029 g/cm²; +3.38%), femoral neck (+0.022 g/cm²; +3.13%), and total hip (+0.021 g/cm²; +2.63%). Metaregression showed that patients with osteopenia benefited comparably to those with osteoporosis. Parathyroidectomy is likely associated with clinically meaningful improvements in bone mineral density at the lumbar spine, femoral neck, and total hip in patients with primary hyperparathyroidism and osteopenia.