This population-based cohort study evaluated the frequency and timing of PHPT-associated end-organ damage (osteoporosis, atraumatic fractures, kidney stones, stage 3+ CKD) and rates of parathyroidectomy among 43,399 adults with a new biochemical PHPT diagnosis, identified from national EHR and claims data (2010–2023).
67% of patients had end-organ damage at diagnosis or on follow-up: 51.3% (22,279/43,399) had damage at diagnosis, and 32.0% (6,762/21,120) of initially undamaged patients progressed after a median 516 days. Despite this burden, parathyroidectomy was performed in only ~20% of patients with end-organ damage — both at diagnosis (4,442/22,279) and after progression (1,348/6,762).
- Study relies on EHR and claims codes, which may misclassify diagnoses or miss under-documented end-organ damage. - No data on reasons parathyroidectomy was deferred (patient preference, comorbidities, surgeon access), limiting causal inference. - Full text is under embargo; additional methodologic details and subgroup analyses are unavailable.
Two-thirds of PHPT patients develop serious end-organ damage, yet parathyroidectomy is used in only about 1 in 5 — suggesting a major care gap. Clinicians should proactively screen for osteoporosis, fractures, kidney stones, and CKD at PHPT diagnosis and revisit surgical referral whenever damage is detected or progresses.
Explore related topics
