Predictors of Nephrolithiasis, Osteoporosis, and Mortality in Primary Hyperparathyroidism

Laura J Reid, Bala Muthukrishnan, Dilip Patel, Jonathan R Seckl, Fraser W Gibb

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

CONTEXT: Primary hyperparathyroidism (PHPT) has a prevalence of 0.86% and is associated with increased risk of nephrolithiasis and osteoporosis. PHPT may also be associated with increased risk of cardiovascular disease and mortality.

OBJECTIVE: To identify risk factors for nephrolithiasis, osteoporosis, and mortality in PHPT.

DESIGN: Retrospective cohort study.

SETTING: University teaching hospital.

PATIENTS: Presented with PHPT between 2006 and 2014 (n = 611).

MAIN OUTCOME MEASURE: Assessment of nephrolithiasis, osteoporosis, and mortality.

RESULTS: Of patients with PHPT, 13.9% had nephrolithiasis. Most had previously documented stone disease, and only 4.7% of asymptomatic patients who were screened for renal stones had calculi identified, not very dissimilar to the rate in the non-PHPT population. Younger age (P < 0.001) and male sex (P = 0.003) were the only independent predictors of nephrolithiasis. Of patients with dual-energy X-ray absorptiometry data, 48.4% had osteoporosis (223/461). Older age (P < 0.001), lower body mass index (P = 0.002), and lower creatinine (P = 0.006) were independently associated with a diagnosis of osteoporosis. Higher PTH was independently associated with lower z score at the hip (P = 0.009); otherwise, calcium and PTH were not associated with lower z scores. Mortality in PHPT was associated with older age (P < 0.008), social deprivation (P = 0.028), and adjusted calcium (P = 0.009) but not independently with PTH at diagnosis.

CONCLUSIONS: Screening for nephrolithiasis has a low yield, particularly in lower risk patients. Osteoporosis is only minimally associated with biochemical indices of PHPT. Mortality is associated with higher calcium (and possibly vitamin D deficiency) but not PTH.

Original languageEnglish
Pages (from-to)3692-3700
Number of pages9
JournalThe Journal of Clinical Endocrinology & Metabolism (JCEM)
Issue number9
Early online date27 Mar 2019
Publication statusPublished - 1 Sept 2019


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