Osteoporosis and/or bone fractures are indications of parathyroidectomy in primary hyperparathyroidism (PHPT), especially in women. However, the benefit of surgery in patients with osteopenia remains unclear. The objective was to evaluate bone mineral density (BMD) and bone remodelling biomarkers changes one year after parathyroidectomy in women with PHPT.

In this prospective, monocentric, observational study, women operated for sporadic PHPT since 2016 with ≥1 year follow-up were included. BMD (dual-X ray absorptiometry) and bone remodelling biomarkers (CTX, P1NP and bone-specific alkaline phosphatases (BAP)) were assessed before and one year after parathyroidectomy.

A total of 177 women with PHPT (62.5±13.3 years, 83.1% menopausal, 43.9% osteopenic and 45.1% osteoporotic) were included. Parathyroidectomy resulted in significant increase in BMD and decrease in serum bone remodelling biomarker concentrations. In the 72 patients with baseline osteopenia, mean BMD significantly increased at the lumbar spine (+0.05 g/cm² (95%CI, 0.03-0.07)), the femoral neck (+0.02 g/cm² (95%CI 0.00-0.04)), the total hip (+0.02 g/cm² (95%CI 0.01-0.02)) and the forearm (+0.01 (95%CI 0.00-0.02)), comparable to osteoporotic patients. Among osteopenic patients, those with individual BMD gain (>0.03 g/cm²) at ≥1 site had higher pre-operative serum CTX, P1NP and urine calcium concentrations than those without improvement.

Parathyroidectomy significantly improved BMD and remodelling biomarkers in women with osteopenia, thereby supporting the benefit of parathyroidectomy in these patients. Preoperative serum CTX and P1NP concentrations could be useful to predict expected BMD gain.