Region Västra Götaland, Närhälsan Norrmalm, Health Centre, Skövde, Sweden.
Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
JAMA Netw Open. 2022 Jun 1;5(6):e2215396. doi: 10.1001/jamanetworkopen.2022.15396.
Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results from previous studies have been inconsistent. Evidence of the association of parathyroidectomy (PTX) with these outcomes is also limited because of the lack of large well-controlled trials.
To investigate whether untreated pHPT was associated with an increased risk of incident fractures and cardiovascular events (CVEs) and whether PTX was associated with a reduced risk of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all patients who were diagnosed with pHPT at hospitals in Sweden between July 1, 2006, and December 31, 2017. Each patient was matched with 10 control individuals from the general population by sex, birth year, and county of residence. The patients were followed up until December 31, 2017. Data analyses were performed from October 2021 to April 2022.
The primary outcomes were fractures, CVEs, and death. Cumulative incidence of events was estimated using the 1-minus Kaplan-Meier estimator of corresponding survival function. Cox proportional hazards regression models were used to calculate hazard ratios (HRs).
A total of 16 374 patients with pHPT were identified (mean [SD] age, 67.5 [12.9] years; 12 806 women [78.2%]), with 163 740 control individuals. The follow-up time was 42 310 person-years for the pHPT group and 803 522 person-years for the control group. Compared with the control group, the pHPT group had a higher risk of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), CVEs (unadjusted HR, 1.45; 95% CI, 1.34-1.57), and death (unadjusted HR, 1.72; 95% CI, 1.65-1.80). In a time-dependent Poisson regression model, PTX was associated with a reduced risk of any fracture (HR, 0.83; 95% CI, 0.75-0.93), hip fracture (HR, 0.78; 95% CI, 0.61-0.98), CVEs (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65).
Results of this study suggest that pHPT is associated with increased risk of fractures, CVEs, and death, highlighting the importance of identifying patients with this condition to prevent serious unfavorable outcomes. The reduced risk of these outcomes associated with PTX suggests a clinical benefit of surgery.
原发性甲状旁腺功能亢进症（pHPT）患者似乎有更高的骨折和其他合并症（如心血管疾病）风险，尽管先前的研究结果不一致。由于缺乏大型对照试验，甲状旁腺切除术（PTX）与这些结果之间关联的证据也有限。
研究未经治疗的 pHPT 是否与更高的骨折和心血管事件（CVE）风险相关，以及 PTX 是否与这些结果的风险降低相关。
设计、设置和参与者：这项队列研究纳入了 2006 年 7 月 1 日至 2017 年 12 月 31 日期间在瑞典医院诊断为 pHPT 的所有患者。每位患者均通过性别、出生年份和居住县与普通人群中的 10 名对照个体相匹配。患者随访至 2017 年 12 月 31 日。数据分析于 2021 年 10 月至 2022 年 4 月进行。
主要结局是骨折、CVE 和死亡。使用相应生存函数的 1-减 Kaplan-Meier 估计值估计事件的累积发生率。使用 Cox 比例风险回归模型计算风险比（HR）。
共确定了 16374 名 pHPT 患者（平均[SD]年龄，67.5[12.9]岁；12806 名女性[78.2%]），并匹配了 163740 名对照个体。pHPT 组的随访时间为 42310 人年，对照组为 803522 人年。与对照组相比，pHPT 组的任何骨折（未校正 HR，1.39；95%CI，1.31-1.48）、髋部骨折（未校正 HR，1.51；95%CI，1.35-1.70）、CVE（未校正 HR，1.45；95%CI，1.34-1.57）和死亡（未校正 HR，1.72；95%CI，1.65-1.80）风险更高。在时间依赖性泊松回归模型中，PTX 与降低任何骨折（HR，0.83；95%CI，0.75-0.93）、髋部骨折（HR，0.78；95%CI，0.61-0.98）、CVE（HR，0.84；95%CI，0.73-0.97）和死亡（HR，0.59；95%CI，0.53-0.65）风险相关。
这项研究的结果表明，pHPT 与骨折、CVE 和死亡风险增加相关，突出了识别患有这种疾病的患者以预防严重不良结局的重要性。PTX 与这些结果风险降低相关表明手术具有临床获益。
Zotero 插件