PDF(Pubmed)
Abstract：
UNASSIGNED: Primary hyperparathyroidism (PHPT) increases the risk of bone loss, debilitating fractures, kidney stones, impaired renal function, and neurocognitive symptoms. Studies describing the natural history of PHPT have been limited to small samples, single institutions, or specific populations.
UNASSIGNED: We assessed the natural history of PHPT through a large, diverse national cohort from an electronic health record dataset representing more than 100 million patients.
UNASSIGNED: The TriNetX database was queried for adult patients with PHPT. We extracted demographics, comorbidities, and longitudinal biochemistries. Primary outcomes included major osteoporotic fracture (MOF) and chronic kidney disease (CKD). Outcomes were stratified by treatment strategy (surgical parathyroidectomy [PTX] vs nonsurgical) and age.
UNASSIGNED: Among 50 958 patients with PHPT, 26.5% were treated surgically at a median of 0.3 years postdiagnosis. At diagnosis, median age was 65 years, 74.0% were female, and median calcium level was 10.9 mg/dL. Black and older patients underwent PTX less frequently than White and younger patients. MOF 10-year incidence was 5.20% (PTX) and 7.91% (nonsurgical), with median 1.7-year delay with PTX compared to nonsurgical. PTX-associated MOF absolute risk reduction was 0.83% (age < 65 years) and 3.33% (age ≥ 65 years). CKD 10-year incidence was 21.2% (PTX) and 33.6% (nonsurgical), with median 1.9-year delay with PTX. PTX-associated CKD absolute risk reduction was 12.2% (age < 65 years) and 9.5% (age ≥ 65 years).
UNASSIGNED: We report 1 of the largest, representative, population-based natural histories of PHPT with different management strategies. A minority of patients underwent PTX, especially in older age. Patients managed surgically had lower incidence of fracture and CKD, and older patients experienced differential benefit.
UNASSIGNED: We assessed the natural history of PHPT through a large, diverse national cohort from an electronic health record dataset representing more than 100 million patients.
UNASSIGNED: The TriNetX database was queried for adult patients with PHPT. We extracted demographics, comorbidities, and longitudinal biochemistries. Primary outcomes included major osteoporotic fracture (MOF) and chronic kidney disease (CKD). Outcomes were stratified by treatment strategy (surgical parathyroidectomy [PTX] vs nonsurgical) and age.
UNASSIGNED: Among 50 958 patients with PHPT, 26.5% were treated surgically at a median of 0.3 years postdiagnosis. At diagnosis, median age was 65 years, 74.0% were female, and median calcium level was 10.9 mg/dL. Black and older patients underwent PTX less frequently than White and younger patients. MOF 10-year incidence was 5.20% (PTX) and 7.91% (nonsurgical), with median 1.7-year delay with PTX compared to nonsurgical. PTX-associated MOF absolute risk reduction was 0.83% (age < 65 years) and 3.33% (age ≥ 65 years). CKD 10-year incidence was 21.2% (PTX) and 33.6% (nonsurgical), with median 1.9-year delay with PTX. PTX-associated CKD absolute risk reduction was 12.2% (age < 65 years) and 9.5% (age ≥ 65 years).
UNASSIGNED: We report 1 of the largest, representative, population-based natural histories of PHPT with different management strategies. A minority of patients underwent PTX, especially in older age. Patients managed surgically had lower incidence of fracture and CKD, and older patients experienced differential benefit.
摘要：
■原发性甲状旁腺功能亢进（PHPT）会增加骨丢失的风险，衰弱性骨折，肾结石,肾功能受损，和神经认知症状。描述PHPT自然史的研究仅限于小样本，单一机构,或特定人群。
■我们通过大量的，来自代表超过1亿患者的电子健康记录数据集的不同国家队列。
■在TriNetX数据库中查询PHPT成年患者。我们提取了人口统计数据，合并症,和纵向生物化学。主要结果包括严重骨质疏松性骨折（MOF）和慢性肾脏病（CKD）。结果根据治疗策略（手术甲状旁腺切除术[PTX]与非手术）和年龄进行分层。
■在50958名PHPT患者中，26.5％在诊断后0.3年的中位数进行了手术治疗。诊断时,中位年龄为65岁,74.0%为女性，钙水平中位数为10.9mg/dL。与白人和年轻患者相比，黑人和老年患者接受PTX的频率较低。MOF的10年发病率为5.20%（PTX）和7.91%（非手术），与非手术相比，PTX的中位延迟为1.7年。PTX相关MOF绝对风险降低分别为0.83%（年龄<65岁）和3.33%（年龄≥65岁）。CKD10年发病率分别为21.2%（PTX）和33.6%（非手术），PTX延迟1.9年。PTX相关CKD绝对风险降低为12.2%（年龄<65岁）和9.5%（年龄≥65岁）。
■我们报告了最大的，代表,基于人群的PHPT自然史，具有不同的管理策略。少数患者接受了PTX，尤其是在老年。手术治疗的患者骨折和CKD发生率较低，和老年患者经历了不同的好处。
■我们通过大量的，来自代表超过1亿患者的电子健康记录数据集的不同国家队列。
■在TriNetX数据库中查询PHPT成年患者。我们提取了人口统计数据，合并症,和纵向生物化学。主要结果包括严重骨质疏松性骨折（MOF）和慢性肾脏病（CKD）。结果根据治疗策略（手术甲状旁腺切除术[PTX]与非手术）和年龄进行分层。
■在50958名PHPT患者中，26.5％在诊断后0.3年的中位数进行了手术治疗。诊断时,中位年龄为65岁,74.0%为女性，钙水平中位数为10.9mg/dL。与白人和年轻患者相比，黑人和老年患者接受PTX的频率较低。MOF的10年发病率为5.20%（PTX）和7.91%（非手术），与非手术相比，PTX的中位延迟为1.7年。PTX相关MOF绝对风险降低分别为0.83%（年龄<65岁）和3.33%（年龄≥65岁）。CKD10年发病率分别为21.2%（PTX）和33.6%（非手术），PTX延迟1.9年。PTX相关CKD绝对风险降低为12.2%（年龄<65岁）和9.5%（年龄≥65岁）。
■我们报告了最大的，代表,基于人群的PHPT自然史，具有不同的管理策略。少数患者接受了PTX，尤其是在老年。手术治疗的患者骨折和CKD发生率较低，和老年患者经历了不同的好处。
