Journal Review in Endocrine Surgery: Parathyroidectomy for Fracture Risk

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Aug 18, 2025

In this engaging discussion, Dr. Becky Sippel, an esteemed leader in endocrine surgery, delves into the often-overlooked condition of primary hyperparathyroidism. With insights from her extensive research, she reveals the severe implications for bone health and the promising benefits of parathyroidectomy, especially in reducing fracture risk. A detailed patient case highlights the diagnostic complexities, and recent studies show how timely surgical intervention can significantly improve outcomes for women with osteopenia. Tune in to uncover why surgery might be the best bet!

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INSIGHT

Disease Burden And Surgical Benefit

Primary hyperparathyroidism is underdiagnosed and causes bone loss, fractures, and renal disease.
Parathyroidectomy substantially reduces fracture risk and improves bone health over time.

ADVICE

Confirm Diagnosis Before Decisions

Confirm primary hyperparathyroidism by correlating mild hypercalcemia with inappropriately high PTH and excluding mimics.
Check vitamin D, kidney function, and 24-hour urine calcium to rule out secondary causes and FHH.

INSIGHT

Forearm DEXA Reveals Hidden Loss

Forearm (radius) bone density often shows the worst loss in hyperparathyroidism.
Adding forearm DEXA can upgrade patients from osteopenia to osteoporosis and change management.

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Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient’s life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature.

Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES. She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery.

Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.

Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.

Learning Objectives:
1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density.

2 Learn about fracture risk associated with primary hyperparathyroidism.

3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.

References:
1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/
2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/
3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/

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