Bone Mineral Density Outcomes after Parathyroidectomy in Patients with Primary Hyperparathyroidism and Osteopenia: A Meta-Analysis and Meta-Regression

ImportanceGuidelines recommend parathyroidectomy for patients with primary hyperparathyroidism and osteoporosis. The use of surgery in patients with osteopenia is contested. ObjectiveTo evaluate the effect of parathyroidectomy on bone mineral density in patients with primary hyperparathyroidism and osteopenia. Data SourcesSystematic searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were conducted through November 2024. Study SelectionEligible 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. Of 642 unique records screened, 18 studies met inclusion criteria. Data Extraction and SynthesisTwo reviewers independently extracted study-level data. Main Outcomes and MeasuresSingle-arm random-effects meta-analysis was performed on mean bone mineral density change after parathyroidectomy at the lumbar spine, femoral neck, total hip and distal radius. ResultsPooled analysis demonstrated significant bone mineral density gains at the lumbar spine (+0.029 g/cm{superscript 2}; +3.38%), femoral neck (+0.022 g/cm{superscript 2}; +3.13%), and total hip (+0.021 g/cm{superscript 2}; +2.63%). Meta-regression showed that patients with osteopenia benefited comparably to those with osteoporosis. Conclusions and RelevanceParathyroidectomy is associated with improved bone mineral density at the lumbar spine, femoral neck and total hip in patients with primary hyperparathyroidism and osteopenia. Consideration can be given to the inclusion of osteopenia as an indication for surgery in future guidelines.