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Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Kyle D. Rudser^*, Ian H. de Boer, Annemarie Dooley, Bessie Young and Bryan Kestenbaum^||

^* Department of Biostatistics, Division of Nephrology, Division of General Medicine, Puget Sound Veterans’ Affairs Medical Center, and ^|| Division of Nephrology, Harborview Medical Center, University of Washington, and Northwest Health Services Research and Development Program, Veterans Affairs Puget Sound Health System, Seattle, Washington

Correspondence: Dr. Bryan Kestenbaum, University of Washington, Division of Nephrology, Harborview Medical Center, Room 10EH11, Box 359764, Seattle, WA 98104-2499. Phone: 206-731-4029; Fax: 206-731-2252; E-mail: brk{at}u.washington.edu

Received for publication January 5, 2007. Accepted for publication May 3, 2007.

The impact of parathyroidectomy (PTX) on the long-term risks for hip and other fractures is unknown. Uncontrolled case series have reported an increase in bone mineral density after PTX. However, very low serum parathyroid hormone levels have been associated with decreased bone mineral density, adynamic bone disease, and fractures. This study compared long-term fracture rates among hemodialysis patients who underwent PTX with a matched control group. Data were obtained from the US Renal Data System. Patients who underwent a first PTX while receiving hemodialysis were matched with up to three control patients by age, race, gender, year of dialysis initiation, primary cause of renal failure, and the dosage of intravenous vitamin D used before PTX. Patients with a history of fracture or renal transplantation were excluded. Study outcomes were incident hip, vertebral, and distal radius-wrist fractures identified using hospitalization codes. Incident hip fracture rates in the PTX and matched control groups were 6.0 and 9.3 fractures per 1000 person-years, respectively. After adjustment, PTX was associated with a significant 32% lower risk for hip fracture (95% confidence interval 0.54 to 0.86; P = 0.001) and a 31% lower risk for any analyzed fracture (95% confidence interval 0.57 to 0.83; P < 0.001) compared with matched control subjects. Fracture risks were lower among hemodialysis patients who underwent PTX compared with matched control subjects. Surgical amelioration of secondary hyperparathyroidism may outweigh the risk of parathyroid hormone oversuppression in terms of bone health.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673