背景:甲状旁腺切除术推荐用于治疗原发性甲状旁腺功能亢进(PHPT),尽管手术后骨折风险降低的程度仍存在不确定性。
目的:比较接受甲状旁腺切除术(PTX)和观察(OBS)的PHPT患者的骨折风险和骨密度(BMD)变化。
方法:我们系统地搜索了PubMed,Embase,和Cochrane图书馆,直到2022年9月,包括随机对照试验(RCT)和队列研究,并回顾了以前评论的引用。
方法:在1,260条初始记录中,来自35项研究(5项随机对照试验;30组)的48篇合格文章包括接受PTX或OBS干预的PHPT患者,在任何部位报告骨折事件。包括臀部,脊柱,或者前臂,和/或BMD在每个位置改变。
方法:遵循两名独立评审员的系统评价和荟萃分析(PRISMA)指南的首选报告项目。
结果:238,188例PHPT患者(PTX:73,778vs.OBS:164,410),甲状旁腺切除术显著减少了任何部位的骨折(RR,0.80;95CI,0.74-0.86)与观察相比。在237,217例患者中(PTX:73,458例vs.OBS:163,759),髋部骨折的风险降低(RR,0.63;95CI,0.52-0.76)。在3,574和3,795例患者中,前臂和椎骨骨折均未减少,分别。PTX组的BMD相对于基线的年度百分比变化较高:股骨颈,1.91%(95CI,1.14-2.68);髋部,1.75%(95CI,0.58-2.92);半径,1.75%(95CI,0.31-3.18);脊柱,2.13%(95CI,1.16-3.10)。
结论:甲状旁腺切除术显著降低了PHPT患者的整体和髋部骨折风险。尽管BMD增加很小,骨折风险的大幅降低表明,除了矿物质含量增加外,PTX还能带来额外的益处.
BACKGROUND: Parathyroidectomy is recommended for curing primary hyperparathyroidism (PHPT), although uncertainty remains regarding the extent of fracture risk reduction following surgery.
OBJECTIVE: To compare fracture risk and bone mineral density (BMD) changes in patients with PHPT undergoing parathyroidectomy (PTX) versus observation (OBS).
METHODS: We systematically searched PubMed, Embase, and the Cochrane Library until September 2022, including randomized controlled trials (RCTs) and cohort studies, and reviewed citations from previous reviews.
METHODS: Among 1,260 initial records, 48 eligible articles from 35 studies (5 RCTs; 30 cohorts) included PHPT patients receiving PTX or OBS interventions with reported fracture events at any site, including the hip, spine, or forearm, and/or BMD changes at each location.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines by two independent reviewers.
RESULTS: In 238,188 PHPT patients (PTX: 73,778 vs. OBS: 164,410), parathyroidectomy significantly reduced fractures at any site (RR, 0.80; 95%CI, 0.74-0.86) compared to observation. In 237,217 patients (PTX: 73,458 vs. OBS: 163,759), the risk of hip fractures decreased (RR, 0.63; 95%CI, 0.52-0.76). No reduction in forearm and vertebral fractures was observed in 3,574 and 3,795 patients, respectively. The annual percentage BMD changes from baseline were higher in the PTX group: femoral neck, 1.91% (95%CI, 1.14-2.68); hip, 1.75% (95%CI, 0.58-2.92); radius, 1.75% (95%CI, 0.31-3.18); spine, 2.13% (95%CI, 1.16-3.10).
CONCLUSIONS: Parathyroidectomy significantly reduced overall and hip fracture risks in PHPT patients. Despite minimal BMD increase, the substantial decrease in fracture risk suggests additional benefits of PTX beyond mineral content enhancement.