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Göteborgs universitets publikationer

Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism

Författare och institution:
Karolina Lundstam (Institutionen för kliniska vetenskaper, sektionen för onkologi, radiofysik, radiologi och urologi, Avdelningen för radiologi); Ansgar Heck (-); Charlotte Mollerup (-); Kristin Godang (-); Marek Baranowski (-); Ylva Pernow (-); Jan Erik Varhaug (-); Ola Hessman (-); Thord Rosén (-); Jörgen Nordenström (-); Svante Jansson (Institutionen för kliniska vetenskaper, sektionen för kirurgi och kirurgisk gastroforskning, Avdelningen för kirurgi); Mikael Hellström (Institutionen för kliniska vetenskaper, sektionen för onkologi, radiofysik, radiologi och urologi, Avdelningen för radiologi); Jens Bollerslev (-)
Publicerad i:
The Journal of clinical endocrinology and metabolism, 100 ( 4 ) s. 1359-1367
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
Context: Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed. Objective: To study the effect of parathyroidectomy (PTX) compared with observation (OBS) on biochemistry, safety, bone mineral density (BMD), and new fractures. Design: Prospective, randomized controlled study (SIPH study), 5-year follow-up. Setting: Multicenter, tertiary referral centers. Patients: Of 191 randomized patients with mild PHPT, biochemical data were available for 145 patients after 5 years, mean age at inclusion 62.8 years (OBS group, 9 males) and 62.1 years (PTX group, 10 males). Intervention: Parathyroidectomy vs observation. Main outcome measures: Biochemistry, BMD and new radiographic vertebral fractures. Results: Serum-calcium and PTH-levels normalized after surgery and did not deteriorate by observation. BMD Z-scores were normal at inclusion in the lumbar spine (LS) and femoral neck (FN). For LS, BMD Z-scores were stable for 5 years with observation, but decreased in FN (P<0.02). After surgery, BMD Z-scores increased significantly in both compartments (P<0.02 for both), with a highly significant treatment effect of surgery compared to observation (P<0.001). During follow-up, 5 new clinically unrecognized vertebral fractures were found in 5 females, all in the OBS group (P=0.058). Conclusion: Even though new vertebral fractures occurred only in the observation group, the frequency was not significantly different from the surgery group. Longer follow-up is needed before firm conclusions can be drawn about the long-term safety of observation, as opposed to surgery.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Kirurgi ->
Endokrin kirurgi
Postens nummer:
Posten skapad:
2015-03-27 10:56
Posten ändrad:
2016-04-28 12:44

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