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The following is a summary of “Factors influencing bone mineral density in hyperparathyroidism phenotypes: a prospective study,” published in the May 2025 issue of Frontiers in Endocrinology by Giocondo et al. 

Primary hyperparathyroidism (PHPT), characterized by elevated parathyroid hormone (PTH) relative to serum calcium and resulting in high bone turnover and decreased bone mineral density (BMD) across its hypercalcemic, normocalcemic, and normohormonal phenotypes, has shown BMD improvement post-parathyroidectomy (PTX), but the relationship between these BMD changes and the specific PHPT phenotypes remains understudied.  

Researchers conducted a retrospective study to determine which PHPT phenotype benefited most from surgery by analyzing symptoms, comorbidities, biochemical profiles, and dual-energy x-ray absorptiometry (DXA) scan results before and after PTX.  

They included 104 individuals with PHPT who underwent PTX. Sociodemographic and biochemical data were collected before surgery and at 6 months postoperative. The DXA scans were completed at 1 and 6 months prior to PTX and again between 12 and 18 months after surgery to evaluate BMD changes. Participants were categorized into normohormonal, hyperparathyroid normocalcemic, and hyperparathyroid hypercalcemic subgroups to compare BMD outcomes across phenotypes.  

The results showed that 40.0% of patients had significant BMD gains at the spine, 35.1% at the femur, 23.5% at the left hip, and 8.6% at the radius. Greater postoperative PTH reductions correlated with larger BMD increases at the spine (SD 0.07; mean 0.03) and left femur (SD 0.06; mean 0.02). No significant T-score changes were observed at the one-third radius. Higher preoperative urinary calcium was linked to improved BMD and T-score at the left hip. All PHPT phenotypes showed comparable BMD improvements, with no differences by sex or correlation with age.  

Investigators concluded that BMD improved after curative PTX in all PHPT phenotypes regardless of age or sex, with greater gains seen in patients with more severe biochemical profiles. 

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1562340/full