P. H. Dedhia1, A. D. McDow1, K. L. Long1, S. L. Pitt1, D. F. Schneider1, R. S. Sippel1 1University Of Wisconsin,Division Of Endocrine Surgery,Madison, WI, USA
Introduction: Primary Hyperparathyroidism can lead to osteoporosis. Guidelines recommend that all patients with primary hyperparathyroidism should undergo a DEXA scan to evaluate for the presence of bone disease. While osteoporosis is more common in women, we sought to determine if there were gender differences in the presence or the evaluation of bone disease in female and male patients with primary hyperparathyroidism.
Methods: This is a retrospective review of a prospective surgical database of 3608 patients with primary hyperparathyroidism who underwent surgical exploration between 2000 and 2018 at a single institution. Clinical characteristics, DEXA scan evaluation, mean t-scores, and the presence of osteopenia or osteoporosis were studied.
Results: Of the 3608 patients with hyperparathyroidism who underwent surgical exploration, 78% (n=2818) were female and 29% (n=790) were male. Female patients were significantly more likely to have a history of either fractures or osteopenia or osteoporosis compared to the male patients (65% vs. 15%, p<0.0001). Furthermore, female patients were also significantly more likely to undergo a DEXA scan during their pre-operative evaluation than male patients, 49% versus 28% (p<0.00001).
In looking at only those patients who underwent a DEXA scan, 86% of women versus 77% of men had osteopenia or osteoporosis as indicated by a t-score of <1.0 (p=0.0008). A diagnosis of osteoporosis was present in 32% of women versus 22% of men (p=0.0035). Mean t-score was -1.71 for women compared to -1.92 for men (p=0.07). Interestingly, men without a history of bone disease or fractures were just as likely to have osteopenia or osteoporosis on DEXA scan as women without history of bone disease or fractures, 54% compared to 61% (p=0.27).
Conclusion: Men with primary hyperparathyroidism are less likely to undergo DEXA scans compared to women. However, our work shows that men and women with no history of bone disease or fractures are equally likely to have osteopenia or osteoporosis on a DEXA scan. These data suggest that the incidence of osteopenia and osteoporosis is likely higher in men than current literature indicates, and that men with a diagnosis of primary hyperparathyroidism without history of bone disease or fractures would benefit from evaluation by DEXA scan.