Highlights
- •The course and outcomes of various diseases may differ between women and men.
- •Patients with primary hyperparathyroidism have some gender-associated differences.
- •The rates of osteoporosis and fractures are the main gender variance.
- •Fracture prevention is a major challenge, especially in post-menopausal women.
Abstract
Objective
To investigate gender-associated differences in the presentation, course, and outcomes
of primary hyperparathyroidism (PHPT).
Study design
A retrospective institutional cohort.
Methods
The database of a tertiary endocrine institute was retrospectively screened for patients
treated for PHPT in 2010–2018. Clinical, biochemical, and imaging data were collected.
Presentation, management, and outcome variables were compared by gender and by age
at diagnosis (<50/≥50 years).
Results
The cohort included 182 women and 161 men diagnosed with PHPT at age 57.6 ± 12.8 and
followed for 6.3 ± 5.5 years. There were no gender differences in age at detection
of hypercalcemia and basal levels of serum and urinary calcium, serum PTH, and serum
25-hydroxyvitamin D. Men had a higher prevalence of nephrolithiasis (33 % vs 21 %,
p = 0.01). Women had a higher frequency of osteoporosis (65 % vs 45 %, p < 0.001),
and a lower mean lumbar spine T-score at PHPT diagnosis. At last follow-up, women
had worse bone mineral density (BMD) results in all measured sites (lumbar spine,
femoral neck, distal radius) and more fractures (34 % vs 20 %, p = 0.004), despite
more frequent and longer pharmacological treatment of osteoporosis. On analysis by
age, all these gender-associated differences were statistically significant only in
patients diagnosed at age ≥50 years. Parathyroidectomy was performed in 52 % of women
and 42 % of men (p = 0.06).
Conclusion
The main differences between male and female patients with PHPT are the higher prevalence,
more intensive pharmacological treatment, and worse outcomes of osteoporosis in women.
Tailoring the optimal medical and/or surgical treatment for fracture prevention in
patients with PHPT remains a major challenge, especially in older women.
Keywords
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Article info
Publication history
Published online: December 14, 2020
Accepted:
November 25,
2020
Received in revised form:
November 24,
2020
Received:
August 30,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
