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Primary hyperparathyroidism associated with an increased risk of fractures and cardiovascular events | 2 Minute Medicine

Primary hyperparathyroidism associated with an increased risk of fractures and cardiovascular events | 2 Minute Medicine

1. In this cohort study, among 16 374 Swedish adult patients with primary hyperparathyroidism, the risk hip fracture was increased by 51%, and risk of cardiovascular events increased by 45% compared to matched healthy participants.

2. Parathyroidectomy was associated with a reduced risk of any fracture, hip fracture, cardiovascular events and death.

Evidence Rating Level: 2 (Good)

Study Rundown: Primary hyperparathyroidism (pHPT) is an endocrine disorder in which individuals have an elevated serum calcium combined with a normal or high blood level of parathyroid hormone. Known concerns of pHPT include increased bone loss and an elevated risk of fractures at sites including the spine, wrist, ribs and pelvis. As such, this retrospective cohort study investigated whether untreated pHPT was associated with an increased risk of fractures and cardiovascular events (CVEs) in comparison with the risk of a sex, age and country-matched control group and whether parathyroidectomy was associated with a reduction in these outcomes. The study included patients who were diagnosed with pHPT at hospitals in Sweden between 2006 to 2017. The primary outcomes were fractures, CVEs, and death. A total of 16 374 patients with pHPT were identified with a mean age of 67.5 years. Compared with the control group, the pHPT group was found to have a higher risk of any fracture by 39%, hip fracture by 51%, CVEs 45% and death 72%. Parathyroidectomy was associated with a reduced risk of any fracture by 17% and death by 59%. A major strength of this study was that in terms of the number of patients with untreated pHPT and multiple observed outcomes, it is the largest analysis performed thus far. As a result of the observational design however, a limitation to this study is that it could not establish causality, although the time-dependent analysis suggested an association between parathyroidectomy and reduced risk of fractures, CVEs and death.

Click to read the study in JAMA Network Open

Relevant Reading: Survival after the diagnosis of primary hyperparathyroidism: a population-based study

In-Depth [retrospective cohort]: This study investigated whether primary hyperparathyroidism (pHPT) was associated with an increased risk of fractures, CVEs and mortality, compared to the risk of a sex, age and country-matched control group. Data was collected from patients diagnosed with pHPT at hospitals in Sweden between July 1, 2006 to December 31, 2017. Each patient was matched with 10 control individuals from the general population. A total of 16 374 patients with pHPT were identified (mean SD age, 67.5 [12.9] years; 12806 women [78.2%]), with 163 740 control individuals. The median follow-up time for the pHPT group was 1.15 (.040-4.06) years and for the control it was 4.62 (2.08-7.51) years. Patients with pHPT had significantly higher risks of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), major osteoporotic fracture (unadjusted HR, 1.43; 95% CI, 1.33-1.54), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), and injurious fall (unadjusted HR, 1.51; 95% CI, 1.42-1.60) compared with those in the control group. The risk of fractures was significantly increased at the following sites: wrist (unadjusted HR, 1.34; 95 CI, 1.18-1.52), upper arm (unadjusted HR, 1.46; 95% CI, 1.25-1.71) and lower leg (unadjusted HR, 1.31; 95% CI, 1.12-1.54). The risk of any CVE for patients with pHPT was increased (unadjusted HR, 1.45; 95% CI, 1.34-1.57), as well as the risk for acute myocardial infarction (unadjusted HR, 1.39; 95% CI, 1.24-1.56) and ischemic stroke (unadjusted HR, 1.51; 95%CI, 1.36-1.68). The risk of death (unadjusted HR, 1.72; 95% CI, 1.65-1.80) was also increased in higher in patients with pHPT compared to the control group. There was a substantial increase in the risk of kidney stones, almost 4 times higher in patients with pHPT (unadjusted HR, 3.65; 95% CI, 3.27-4.08) than in control individuals. Of the 16 374 patients with pHPT, 6934 (42.3%) underwent a parathyroidectomy. While using the Poisson regression model to study the pHPT group separately, parathyroidectomy was found to be associated with a reduced risk of hip fracture (HR, 0.78; 95% CI, 0.61-0.98), any fracture (HR, 0.83; 95% CI, 0.75-0.93), injurious fall (HR, 0.83; 95% CI, 0.74-0.92), CVE (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65).

Image: PD

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As special events begin to ramp up after COVID-19 impacts, there are several events taking place this weekend including a concert at the United Center, Chicago Fire Soccer home opener at Soldier Field and the Polar Plunge on Sunday at North Avenue Beach. OEMC reminds participants and spectators to be aware in crowds and call 9-1-1 to report any suspicions of criminal or terrorist activity.

Chicago Fire Home Opener and United Center Concert, Saturday, March 5
Soldier Field: Chicago Fire home opener is at Soldier Field with its earliest start in its history on Saturday. The Chicago Fire opens their 2022 season against the Orlando City SC at 5 p.m.
United Center: New Edition: The Culture Tour with Charlie Wilson + Jodeci on Saturday begins at 8 p.m., with gates open at 6:30 p.m.

The Chicago Polar Plunge, Sunday, March 6
North Avenue Beach: The Chicago Polar Plunge is headed back to the beach with all the polar plungers, volunteers, and supporters on Sunday at North Avenue Beach, located at 1600 N. Lake Shore Drive. Registration opens at 8 a.m., with opening ceremonies beginning at 9:45 a.m. The plunges will happen in waves, beginning at 10 a.m.

The Office of Emergency Management and Communications (OEMC) will monitor all citywide events, activities, traffic, and weather conditions throughout the weekend from the Operations Center and coordinate public safety resources as needed with all necessary agencies.

Pole Marker Locations: For public safety, residents are reminded to be aware of the numbers attached to the poles throughout the Grant Park area to help them reference their location within the park to friends, family and first responders if there is an emergency. Pole markings are established within the boundaries of Roosevelt Rd. to Randolph St., Lake Shore Drive (LSD) to Michigan Avenue, Ida B Wells Dr to Michigan Ave to Columbus Dr, Jackson St to Michigan Ave, Monroe St to Columbus Dr, 3900 LSD to 6600 LSD.

Motorists in the areas where events are happening should be prepared for heavy traffic and possible reroutes. To ensure public safety, Traffic Control Aides (TCAs) will be on hand at events citywide to direct flow and impacts from heavy traffic. Public transportation is encouraged. For more information on CTA services and reroutes, visit or call 312-836-7000 from any area code/1-888-YOUR-I CTA.

Report Suspicious Activity: If you See Something Say Something. The city reminds the public to be aware of their surroundings and to report suspicious activity. If you notice something suspicious, notify onsite security or call 9-1-1. If You See Something, Say Something™ is a national anti-terrorism public awareness campaign that emphasizes the importance of reporting suspicious activity to law enforcement authorities.

Smart911: Residents with an existing or new Smart911 safety profile can volunteer to share with police recorded home surveillance camara footage should a crime occur nearby or outside their residence. By simply opting in on an existing Smart911 profile or by creating a new profile at, residents can agree to share home surveillance camera footage by allowing the CPD to contact them in the event of a crime. All information is private.

OEMC will issue any alerts and notifications needed to keep residents and attendees up to date on weather conditions and emergencies. Sign up for NotifyChicago alerts at OEMC also issues TEXT alerts for lakefront notices, issues affecting businesses or COVID-19 updates:
CHILAKE: For lakefront notices, TEXT “CHILAKE” to 7-8-0-1-5
CHIBIZ: For alerts affecting businesses, TEXT “CHIBIZ” to 6-7-2-8-3
COVID: Get COVID-19 updates by TEXTING “COVID19” to 6-7-2-8-3

For additional information on emergency preparedness information, visit the OEMC website at Follow the Office of Emergency Management and Communications onFacebook (@coemc), Twitter (@ChicagoOEMC) and Instagram (chicago_oemc_911).

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